HealthPartners Dental Claims Consultant (Dentist) in Bloomington, Minnesota
Dental Claims Consultant (Dentist) Job ID: 47946 Department: Dental Plan Admin GHI City: Bloomington, MN Location: DN - Bloomington 8170 Bldg Position Type: Full-Time Position Information: HealthPartners has an exciting opportunity for a Dental Claims Consultant (Dentist). This is a permanent, full time (.80 FTE) position at our main office in Bloomington. This person will evaluate and make professional judgments/decisions as to the appropriateness of treatment for dental procedures in accordance with dental contracting and policy requirements as specified. This decision making applies to both members with commercial contracts and for members whose coverage is with government programs. At HealthPartners, you'll find a culture where we live our values of excellence, compassion, integrity and most importantly, partnership. By working together, we will improve health and wellbeing, create exceptional experiences for those we serve and make care and coverage more affordable. ACCOUNTABILITIES: Responsibility for reviewing dental claims and predetermination of dental treatment plans to determine reasonableness of treatment as it relates to plan contract provisions, dental plan benefits, dental claims administration policies and current standards of dental practice. Review radiographic images, chart notes, narratives, periodontal charting and other diagnostic information needed to determine if sufficient clinical documentation warrants approval of coverage for treatment. Responsibility to review appeal requests. Help identify dental coding issues, educational needs and corrective actions related to the structure and delivery of care by dental health care professionals. Responsibility to provide timely responses and effectively communicate clinical decision of reviews. Ability to work directly with the dental claims supervisor and staff, dental and medical directors, member service and appeals representatives and other healthcare professionals and administrative personnel. Communication with providers regarding coverage decisions. Compliance with the timeliness of decisions as specified by contract and statute. Archiving case documentation for future reference or audit purposes. Collaborate with the Assistant Dental Director with respect to provider and plan audits. REQUIRED QUALIFICATIONS: A current and unrestricted license to practice dentistry in the State of Minnesota. A minimum of 5 years of clinical private practice experience in addition to any experience in the dental education setting. Functional computer skills, including Excel, Word, PowerPoint, Outlook and Internet Explorer. Experience with professional claim/utilization review. Knowledge of the community standards of oral healthcare delivery and dental care benefit administration. Ability to quickly learn and master the intricacies of a variety of IT systems. Excellent analytical, quantitative and problem solving skills. Ability to work well independently and as a contributing member of a team. HealthPartners offers a comprehensive benefits package. To see a complete job description and/or to apply for this position, please visit , click on job opportunities and search for Job ID #47946. Contact Information: We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.