Dental Liaison

Ameritas

Lincoln, NE Technology
Utilize dental knowledge to perform dental insurance utilization review.

At Ameritas, fulfilling life is what we do daily. We continuously strive to help our customers and employees enjoy life at its very best by reducing uncertainty, helping grow assets and protecting what is most cherished. We're here to help people put worry behind and the future ahead and help enable a life that's rich in family, happiness, health and financial security. When lives are fulfilled, our mission is fulfilled.

Ameritas Life Insurance Corp is seeking a Dental Liaison to perform the initial screening of claims requiring utilization review. Liaisons will not interpret or evaluate clinical information, but instead will review each procedure request according to the specific clinical criteria/guideline. The role of the Liaison is limited to the collection and transfer of non-clinical data and the acquisition of structured clinical data.

If the clinical criteria/guidelines are met, the Liaisons make a review determination by indicating the approval decision on the consultant notepad. If the clinical criteria/guidelines aren't met, the liaison refers the claim to the appropriate dental consultant for review. Adverse benefit determinations are not issued by the liaisons.

Essential Functions:

* Review each procedure request according to the specific clinical criteria/guideline.
* Approve claims that meet the liaison guideline and refer all others to the dental consultants. Does not evaluate or interpret clinical information.
* Review provider practice patterns that are outside of the norm.
* Apply policy provisions and knowledge of company philosophy to ensure compliance with the contract, legal requirements and guidelines established by various state and federal regulations, URAC standards and "Best Practices and Procedures" within Customer Connections and Operations. Partner with Group Compliance to assure requirements are implemented appropriately.
* Proficient in using the claims/image system and various sub-systems. Knowledge of various contracts including PPO, special marketing arrangements and service guarantees. The individual must be sensitive to arrangements requiring them to represent strategic alliances.
* Contact dental offices to interpret procedures and obtain information and/or supporting documentation.
* Serve as liaison between the Customer Connections associates and dental consultants.
* Analyze claim discrepancies to ensure claim is processed accurately and make appropriate adjustments.
* Screen claims to determine areas of associate development and possible system enhancements

Other possible duties as assigned:

* Assist the Dental Liaison Records Specialist when needed
* Assist in the mentoring of associates as assigned by department management.
* Additional responsibilities as assigned by department management.
* Evaluate adjudication process to determine if system logic is appropriate.

Required Knowledge and Skills:

* Post-secondary training or two years clinical experience either as a Dental Assistant or Dental Hygienist required
* Completed radiology training required
* Professional written and verbal communication skills are required
* Strong initiative for assessing situations, problem solving, and using analytical skills to determine the best course of action are all required
* Demonstrated ability to be adaptive to change and improvement required
* Ability to establish relationships with a diverse group of people required
* Proficiency with personal computer system and keyboarding skills required

We are Ameritas: proud to say we're in the business of fulfilling life.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Job ID: 2922

Posted about 1 month ago

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