Primary Job Duties & Responsibilities
This position supports the daily processing of appeals in the Par Provider Dental Appeals.
Job functions include, completing appeals determination letters, prepping dental requests, updating systems, completing reporting as necessary, working collaboratively with clinical support staff (Medical Directors, Nurses, Providers, etc.), and movement of cases in the MedHok system.
All work is to be handled in compliance of turnaround times and regulatory standards.
Responsible for managing to resolution complaint/appeal scenarios for dental products, which may contain multiple issues and may require coordination of responses from multiple business units. Ensure timely, provider focused response to complaints/appeals.
Identify trends and emerging issues and report and recommend solutions.