DentaQuest Hiring for Utilization Management Support Specialist Job at Remote Full Time

The Utilization Management Support Specialist provides various critical components necessary to day-to-day operational functions while ensuring proper workflow between the Utilization Management Department, providers and internal departments. The Utilization Management Support Specialist coordinates Continuation of Care orthodontic benefits.

PRIMARY JOB RESPONSIBILITIES:

• Determine dollar amount, calculate financial responsibility, and enter Orthodontic Continuation of Care cases based on prior claims submitted, submitted explanation of benefits, treatment plan and other supporting documentation.
• Review, research and respond to inquiries routed via telephone, follow-ups, and email.
• Investigate and manage orthodontic reimbursement inquiries with Client/Provider Engagement, Claims, and Customer Service departments.
• Verbally communicate authorization decisions to providers, request additional information when necessary, and appropriately document the phone call in DentaQuest’s system.
• Coordinate, manage and distribute incoming faxes to facilitate distribution to appropriate parties within the organization.
• Assemble Ortho CAD (electronic orthodontic requests) submission forms in preparation for review.
• Prepare and Coordinate general anesthesia/IV requests
• Organize, coordinate and communicate Outpatient Facility Requests to appropriate State and/or Managed Care Organizations.
• Process requests received in the Outpatient Facility Specialist queue.
• Communicate to management ways to improve processes and productivity of company.
• Adhere to DentaQuest business processes.
• Assist with administrative and other duties as assigned.

• High School Diploma or equivalent.
• 1 year experience in clerical setting
• Knowledge of general computer software.
• Knowledge of telephone systems.
• Knowledge of dental terminology.
• Typing skills of 30+ wpm.
• Ability to read Explanation of Benefits.
• Good interpersonal skills.
• Ability to work independently.
• Good PC Skills.
• Excellent verbal communication skills.
• Excellent mathematical skills.
• Excellent analytical skills.
• Good judgment and ability to resolve payment issues.
• Ability to prioritize and organize multiple tasks.
• Ability to remain organized with multiple interruptions.
• Required to attend additional training as requested/deemed necessary.