About Avēsis:
Avēsis is a leading provider of supplemental benefits, committed to improving patient care and supporting dental professionals. Our remote work environment offers flexibility, career growth, and competitive compensation.
Position Overview:
We are seeking a Utilization Management (UM) Clinical Dental Processor to evaluate dental treatment requests, ensure adherence to clinical guidelines, and maintain compliance with organizational policies. This remote role involves reviewing dental records, x-rays, models, and supporting documentation to determine the appropriateness of dental services prior to provision.
Key Responsibilities:
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Conduct utilization management reviews of prior authorizations for dental services.
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Apply national clinical criteria to assess treatment necessity.
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Review patient histories, x-rays, models, and photos.
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Complete clinical scripts and enter documentation into internal systems.
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Maintain departmental productivity standards (20 cases/hour).
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Collaborate virtually with teams using Microsoft Teams and Outlook.
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Ensure confidentiality and compliance with HIPAA and company policies.
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Recommend process improvements and optimize workflows.
Minimum Qualifications:
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High School Diploma/GED required.
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Dental Assistant or Dental Hygienist certification; X-Ray certification preferred.
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1–2 years of experience reviewing dental charts, x-rays, or photos.
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Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook).
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Reliable internet connection and dedicated workspace for remote work.
Preferred Qualifications:
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Knowledge of Medicare, Medicaid, or commercial insurance.
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Familiarity with HCPCS, CPT, CDT, and ICD-10 coding.
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Experience in utilization management or prior authorization.
Skills:
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Strong communication, organization, and time management.
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Attention to detail and ability to work independently.
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Critical thinking and problem-solving skills.
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Ability to manage multiple priorities in a fast-paced environment.
Why Avēsis:
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Competitive pay and benefits (medical, dental, 401k, tuition assistance).
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Flexible work hours and remote-friendly environment.
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Opportunities for career growth and professional development.
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Inclusive, diverse, and collaborative culture.
Apply Now to join Avēsis and make a meaningful impact in dental utilization management.