Dental Liaison Records Specialist

Ameritas

Lincoln, NE Technology
Use your dental knowledge outside a clinical setting.

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 Records Specialist to drive the business by handling dental claims in accordance with the specific policy and processing arrangement, utilization review guidelines and the Current Dental Terminology © American Dental Association. Provides support to the dental liaison and dental consultant by handling administrative and regulatory duties to ensure compliance with state and federal regulations and URAC standards. Provides customer service to exceed customer expectations and achieve customer loyalty through the application of "Best Practices". Interacts with dental consultants and dental liaisons to review dental procedures and claims to determine benefits outlined by contract provisions and confirm proper procedure coding to ensure benefits support contract ratings and experience.

Essential Job Functions

* Recognize dental codes, tooth numbers and procedures and know how they interrelate to ensure claim was reported appropriately. Reviews radiographs, periodontal charting, and narratives for verification of the submitted procedure.
* 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.
* Work with Quality Control and manager to coordinate appeal panel reviews and resolve any clinical rationale requests, expedited appeals and urgent care claims.
* Resolve inquiries and problems and arrive at a quick, accurate and satisfactory resolution.
* Enter data on external dental consultant's website, attach supporting documents and record the external dental consultants benefit determination on the claim system in accordance with the departmental accuracy and responsiveness standards using the claims/image system and sub-systems.
* Facilitate response to claims for review by internal dental consultants conducted in other modes than the claims/image system. Accurately track these claims to ensure timely resolution.
* Effectively communicate with dental offices to verify procedures and obtain information and/or supporting documentation needed to resolve claim outcomes. Also conduct proactive telephone calls to dental offices to fulfill state regulations in the required timeframes.
* Exceed standards of customer service through timely, courteous and diplomatic handling of customer interactions for internal and external customers.
* Achieve acceptable turn-around-time for responding to inquires via all communication modes in a professional manner that reduces the need for further inquiries, providing accurate and complete information
* Determine and communicate to Group Support Services the date radiographs can be destroyed or returned via mail to dental providers.
* Utilize the claim system efficiently, including attaching supporting documents received from claims clearinghouses in order for utilization review to be performed.
* Ability to work periods of overtime as required based on business need.

Qualifications

* Post-secondary training/education or two years clinical experience as a Dental Assistant
* Must have completed radiology training.
* Excellent verbal and written communication skills
* Adaptive to change and improvement
* Proficient use of personal computer system and keyboarding skills.
* Interpret written information and transcribe accurately and efficiently
* Ability to work independently.

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

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Job ID: 3623

Posted about 1 month ago

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