Appeals Professional III (Dental Hygienist)

Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications.  Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.

*This position is located Remote United States*

*This is a part-time position*

Position Purpose

Reviews appeals for denied dental services in a Medicare Advantage Plan. 

Essential Responsibilities

• Reviews dental records/case file, writes a reconsideration/dispute resolution decision that is clear, concise, and impartial and supports the determination made, and documents review.
• Makes sound, independent decisions based on medical or dental evidence in accordance with statutes, regulation, rulings, and policy.
• Responds to and ensures that all appeal/dispute issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
• Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
• Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision.

Minimum Qualifications

Education

•  Graduate from a Dental Hygiene program accredited by the commission on Dental Accreditation (CODA)
•  Passed the National Board of Dental Hygiene Examination (NBDHA)

Experience

• Three (3) years experience as a dental hygienist
• Currently have or have had direct patient care within the last three years

Benefits

C2C offers an excellent benefits package, including:

• Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
• Section 125 plan
• 401K
• Competitive salary
• License/credentials reimbursement
• Tuition Reimbursement

EOE Vet/Disability