Dental Benefit Examiner - Remote

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is remote within the state of AZ only.  This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

PRUPOSE OF THE JOB

The Dental Benefit Examiner is responsible for data entry, review, and processing of dental prior authorization, retro-review requests, and referral requests.

REQUIRED QUALIFICATIONS

Required Work Experience

• Two years of dental administrative/clinical experience required

Required Education

• High school degree or equivalent GED required

Required Licenses

• NA

Required Certifications

• NA

PREFERRED QUALIFICATIONS

Preferred Work Experience

• Minimum one year of experience in a managed care organization or related healthcare delivery system

Preferred Education

• NA

Preferred Licenses

• NA

Preferred Certifications

• Dental assisting certification preferred

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Processes prior authorization requests and retro-reviews indicating final consultant or department determination, and securely inform providers of decisions
• Processes referral requests in accordance with clinical review criteria
• Answers incoming provider calls to research, and bring resolution to provider questions, problems, or concerns
• Verifies eligibility for coverage of dental benefits to avoid duplication of services and duplication of billing
• Works in conjunction with the dental director by recommending consultant review when appropriate medical-necessity authorization is necessary
• Communicate with providers on member-related issues
• The position has an onsite expectation of 0 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

REQUIRED COMPETENCIES

Required Job Skills

• Dental administrative/clinical experience
• Ability to read and interpret dental x-rays
• Computer experience in Microsoft Excel, Word, Outlook

Required Professional Competencies

• Knowledge of Medicaid and Medicare regulations and guidelines
• Knowledge of dental coding and terminology
• Knowledge of HIPPA regulations

Required Leadership Experience and Competencies

• Effective time management skills
• Effective interpersonal and communication skills
• Ability to prioritize work tasks to adhere to deadlines and identified time frames
• Ability to work cooperatively, positively, and collaboratively in a team environment