Ameritas Dental Insurance Company
At Ameritas, fulfilling life is what
we do daily. We continuously strive to help our customers and employees enjoy life at its very best by reducing uncertainty,
helping grow assets and protecting what is most cherished. We're here to help people put worry behind and the future ahead
and help enable a life that's rich in family, happiness, health and financial security. When lives are fulfilled, our mission
The Dental Liaison will perform the initial screening claims requiring utilization review. Liaisons
will not interpret or evaluate clinical information, but will review each procedure request according to the specific clinical
criteria/guideline. The role of the Liaison is limited to the collection and transfer of non-clinical data and the acquisition
of structured clinical data.
If the clinical criteria/guidelines are met, the Liaisons make a
review determination by indicating the approval decision on the consultant notepad. If the clinical criteria/guidelines aren't
met, the liaison refers the claim to the appropriate dental consultant for review. Adverse benefit determinations are not
issued by the liaisons
Review each procedure request
according to the specific clinical criteria/guideline.
Approve claims that meet the liaison guideline and refer all others to the dental consultants.
Does not evaluate or interpret clinical information.
Review provider practice patterns that are outside of the norm.
Apply policy provisions and knowledge of company philosophy to ensure compliance with the contract,
legal requirements and guidelines established by various state and federal regulations, URAC standards and "Best Practices
and Procedures" within Customer Connections and Operations. Partner with Group Compliance to assure requirements are
Proficient in using
the claims/image system and various sub-systems. Knowledge of various contracts including PPO, special marketing arrangements
and service guarantees. The individual must be sensitive to arrangements requiring them to represent strategic alliances.
Contact dental offices to interpret procedures and obtain information
and/or supporting documentation.
Serve as liaison between
the Customer Connections associates and dental consultants.
Analyze claim discrepancies to ensure claim is processed accurately and make appropriate adjustments.
Screen claims to determine areas of associate development and possible
system enhancements Assist the Dental Liaison Records Specialist when needed Assist in the mentoring of associates as assigned
by department management.
as assigned by department management.
process to determine if system logic is appropriate.
Required Knowledge and Skills:
training or two years clinical experience either as a Dental Assistant or Dental Hygienist Must have completed radiology training.
Strong initiative for assessing situations.
Excellent communication skills
Problem solving and analytical skills are required to determine best course
Adaptive to change and improvement
Ability to establish relations with a diverse group of people.
Proficient use of personal computer system and keyboarding skills.
We are Ameritas: proud to say we're in the business of fulfilling
Contact: Anne Otto at firstname.lastname@example.org