Dental Appeals Analyst — Clinical & Compliance

Socket.dev; Maryland; Remote; USD 29,000 - 62,000; Full time

Job summary

CVS Health in Maryland is seeking a full-time Dental Appeals Processor to support the daily appeals workflow for the Par Provider Dental Appeals team. You will complete determination letters, prep dental requests, and update multiple systems, collaborating with Medical Directors, Nurses and Providers to move cases through MedHok efficiently.

Applicants should understand contemporary dental care standards and radiograph interpretation, and maintain required continuing education if licensed.

Qualifications

• Comprehends contemporary dental care standards, practices, and procedures.
• Possesses high level of radiograph interpretation skills.
• If certified or licensed, maintains required continuing education requirements.

Responsibilities

• Support the daily processing of appeals in the Par Provider Dental Appeals.
• Complete appeals determination letters and prepping dental requests.
• Update systems and generate reports as necessary.
• Work collaboratively with clinical support staff (Medical Directors, Nurses, Providers, etc.).
• Move cases in the MedHok system, ensuring turnaround times and regulatory compliance.
• Identify trends and report emerging issues with recommended solutions.

Skills

Dental standards

Radiograph interpretation

CE requirements

Education

Vocational school or college level training beyond high school

CDA. RDA, RDH with at least five years clinical experience

Job description

CVS Health in Maryland is seeking a full-time Dental Appeals Processor to support the daily appeals workflow for the Par Provider Dental Appeals team. You will complete determination letters, prep dental requests, and update multiple systems, collaborating with Medical Directors, Nurses and Providers to move cases through MedHok efficiently.

Applicants should understand contemporary dental care standards and radiograph interpretation, and maintain required continuing education if licensed.