Claims Review Dentist or Oral Surgeon (Remote)

Capitol Bridge; United States; Remote; USD 125,000 - 150,000; Full time

Job summary

An established industry player is seeking an experienced Claims Review Dentist or Oral Surgeon to join their team. This pivotal role involves resolving claim disputes within Florida's healthcare system, ensuring compliance with state regulations and guidelines. The ideal candidate will have a strong clinical background, excellent communication skills, and the ability to manage sensitive information with discretion. Join a dynamic team where your expertise will contribute to fair and efficient dispute resolution in the healthcare sector. This role offers a competitive hourly rate and the opportunity to make a significant impact in the field.

Qualifications

• Five years of full-time clinical care experience.
• Licensed in the required specialty with recent clinical experience.

Responsibilities

• Conduct impartial assessments of documentation from both parties.
• Review medical documentation to determine medical necessity.

Skills

Clinical Care Experience

Claims Review Process

Communication Skills

Organizational Skills

Education

Licensed in Required Specialty

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

About Capitol Bridge

Founded in 2012, Capitol Bridge is based in Arlington, Virginia, with expertise in providing independent medical reviews, records/data management services, medical coding, administrative staffing, and eligibility reviews.

We are actively seeking an experienced 1099 Claims Review Dentist or Oral Surgeon. This role is crucial in the Florida Statewide Health Plan Claim Dispute Resolution Program under the Agency for Health Care Administration, ensuring fair and efficient resolution of claim disputes.

The successful candidate will resolve claim disputes submitted by physicians, hospitals, institutions, pharmacies, and other healthcare providers. They will also assist contracted and non-contracted healthcare providers and health plans in resolving claims disputes within Florida statutes and administrative codes. The role requires conducting duties efficiently, promptly, productively, consistently, and courteously, maintaining professionalism.

Salary Range: $134 per hour, estimated review time per case is approximately 2 to 6 hours.

Key Responsibilities

1. Conduct impartial assessments of documentation from both initiating and responding parties.
2. Review medical documentation to determine the medical necessity or appropriateness of services or procedures in dispute.
3. Utilize governmental and professional guidelines to support determinations.
4. Adhere to company policies, state regulations, and project guidelines.
5. Maintain effective communication and ensure timely completion of reviews.
6. Follow QA/QC processes and meet departmental standards.
7. Uphold scheduling commitments and privacy regulations.
8. Perform other duties as directed by leadership.

Required Qualifications

• Licensed in the required specialty.
• Five years of full-time clinical care experience.
• Recent clinical care experience within the past three years.
• Non-restricted license in any US state; physicians must have current certification by a recognized American medical specialty board.

Preferred Qualifications

• Familiarity with claims and claim review processes.
• Experience navigating electronic documents such as PDFs, Microsoft Excel, Word, and Outlook.
• Ability to manage sensitive information with discretion.
• Strong organizational, communication, and teamwork skills.
• Ability to prioritize tasks effectively.

Additional Information

Screenings: Background check required; employment contingent upon successful completion.

Reasonable Accommodation: Applicants needing alternative application or screening methods should contact the employer directly.

EEO Statement: Capitol Bridge LLC is an Equal Opportunity Employer, committed to diversity and inclusion in the workplace.

Texting Notice: We may contact applicants via text regarding this position or application status; opt-out options are available.