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Requisition Number: 1242
Job Title: Dental Consultant
Number of Positions: 1
Position Type:
Area of Interest: Professional Services
City: Little Rock
State / Province: Arkansas
Job Description: Everyone’s born with a smile. At Delta Dental of Arkansas, we believe it’s our job to keep it healthy. As the state’s largest dental insurance provider, our employees play a vital role in our continued success. We work hard to attract and retain the very best talent in Arkansas. It is because of our strong commitment to employee satisfaction that Delta Dental was named one of Arkansas’ Best Places to Work by Arkansas Business for five consecutive years. We offer a competitive compensation and benefits package, a family-friendly work environment and professional development opportunities.

This position is a part-time position that does require in house work at our Little Rock location.

Job Summary: To review certain dental claims from a clinical perspective to determine benefits allowed based upon guidelines of the group contract.

Primary Job Responsibilities:
1. Reviews certain claims to include attachments (e.g. radiographs, periodontal charting, photos, narratives, and patient chart notes/progress notes) and make a determination to approve, deny, disallow, or allow alternate treatment based upon guidelines of the group contract.
2. Administers claim review utilizing current processing policies/guidelines/standards, DeltaUSA processing policies, group contracts, provider agreements and state laws applicable to claims adjudication.
3. Investigates, makes determinations, performs or coordinates adjustments on difficult provider claim appeals, confers with treating dentists on questionable treatment cases when indicated, and documents results.
4. Keeps current on ADA CDT procedure codes, DeltaUSA processing policies, DDAR processing policies, policies of self-funded groups, and current dental techniques and procedures.
5. Coordinates with Dental Review Specialists on issues relating to specific claim reviews when additional information is needed.
6. Provides dental expertise and/or interpretation of dental policies, procedures codes and processing guidelines to internal and external contacts.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Requirements: Minimum Qualifications:
Position requires a current, unrestricted license to practice dentistry in Arkansas. Must have at least ten (10) years of clinical experience in the practice of dentistry. Experience reviewing claims preferred. Must be qualified to render a clinical opinion about dental conditions, procedures, and treatment. Must have knowledge of dental terminology. Must be able to read and interpret radiographs. Must have good oral and written communication skills. Must have moderate computer skills. Will accept any suitable combination of education, training or experience.
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