Avēsis · 16 hours ago
Utilization Management Clinical Processor
United States
Full-time
Remote
Entry Level
$18.33/hr - $35.84/hr
1+ years expAvēsis is a leading provider of supplemental benefits, seeking a Utilization Management Clinical Dental Processor to leverage dental clinical expertise in reviewing dental x-rays and documentation for prior authorizations. The role involves evaluating service requests, ensuring compliance with clinical criteria, and maintaining productivity standards while working in a remote environment.
Insurance
Responsibilities
Conducts reviews of prior authorizations by providers -- determining cases of recommended treatment in accordance with Avesis UM procedural guidelines or refers the case to Clinical Director or consultant for professional review of clinical denials
Ensures that the right systems, processes, and measurements are in place to assist with accurate clinical determinations are rendered
Understands and upholds Avesis’ policies and obligations relative to the UM reviews required by each client contract
Documents approval decisions for treatment in accordance with prescribed UM department procedural guidance, and forwards applicable files to the client health plan as required by each contract
Provide recommendations on department policies, objectives, and initiatives. Evaluate and suggest changes as necessary to optimize processes and efficiencies. Works in partnership with Avēsis personnel to improve system efficiency and collaborate on complex barriers that arise
Maintains a daily level of productivity in accordance with departmental requirements for production and quality standards
Maintains effective intradepartmental communications through sharing of plans, general company news and other information through informal interactions; and actively participates in routine departmental meetings
Other Duties as assigned
Qualification
Required
High School Diploma/GED
Dental Assistant or Dental Hygienist required
Dental Assistant certificate or 2 years of chair side assisting
1-2 years of experience reviewing dental x-rays, models, photos, and patient charts required
Proficiency with Microsoft Office and other Windows-based applications
Strong reading, writing, and professional communication skills
Ability to manage multiple tasks and prioritize work
Adaptability to handle multiple and changing priorities
Effective time management and organizational skills
Access to reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role
Preferred
X-Ray certification is highly preferred
Knowledge of Medicare, Medicaid, or commercial insurance
Experience with HCPCS, CPT, CDT, and ICD-10 coding
Benefits
Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
Life and disability insurance.
A great 401(k) with company match.
Tuition assistance, paid parental leave and backup family care.
Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
Employee Resource Groups that advocate for inclusion and diversity in all that we do.
Social responsibility in all aspects of our work.
Company
Avēsis
Guiding you to wellness with innovative tools, equitable access, and a personal touch.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Sean Slovenski
Chief Executive Officer
Karim Bennis
Executive Vice President, Chief Operating Officer
Recent News
2024-01-03
2023-09-26
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