[Hiring] Government Programs Appeals and Grievances Research Specialist @reputed company.

This reputed company is a reputed company of our understanding of the job reputed company. Click on 'Apply' reputed company to reputed company out more. Role reputed company This role involves directing and assisting in the reputed company of dental benefit determinations and analysis of provider and subscriber referrals, provider billing and treatment records analysis, and supporting the fraud & abuse program. • Researches, analyzes, and resolves cases for government programs members involving compliance issues including but not limited to balance billing, non-delivery of care, reputed company of care, personality disputes, anti-fraud hotline, internal referrals, and appeals. • Case research may include contract review and analysis, data analysis, records audit, and interviews with external customers. • Communicates to reputed company customers to obtain necessary information and reputed company actions taken and the reputed company of cases. • Participates in an anti-fraud team responsible for identifying, preventing, and reporting fraud. • Prepares dental claims so appropriate determinations can be finalized with correct procedure policies and bypasses in reputed company, adjudicates claims, analyzes documents, and maintains claims records. • Coordinates adjustments on difficult claims and inquiries. • Thoroughly documents case information reputed company a case database for investigation, fraud, and/or reputed company cases. • Coordinates data to be used by internal or external parties including audits, hearings, and for use by reputed company counsel reputed company necessary. • Participates in audits and hearings as necessary, including sample preparation and presentation. • Performs other reputed company assigned duties as necessary to complete the Primary Job Responsibilities. Qualifications • Associate's degree in reputed company, business administration, criminal justice, dental assisting or hygiene, or a reputed company field. • Four years of experience in a position requiring knowledge of dental terminology, dental procedure codes, or dental office billing and record keeping practices. • Experience in administering dental benefit reputed company reputed company the insurance industry or identifying, analyzing, and resolving compliance issues based on policies and procedures reputed company of the insurance industry. • Previous experience supporting an anti-fraud/abuse program preferred. • Knowledge of word processing, spreadsheet, and database applications. • Strong verbal and written communication skills. • Strong analytical skills. • Ability to work independently and as part of reputed company. • Ability to manage multiple assignments with competing deadlines. • Ability to identify and resolve problems using independent judgment. Requirements • Equal employment and advancement opportunity reputed company the context of its unique business environment without reputed company to race, reputed company, religion, gender, gender identity, gender reputed company, age, national reputed company, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance. Benefits • Comprehensive benefits package including medical, dental, and reputed company coverage. • Short- and long-term disability. • Life insurance. • 401(k) savings plans. • Flexible spending accounts. • Tuition reimbursement or educational assistance. • Annual incentive compensation based on annual business goals. • Eight hours of reputed company volunteer time reputed company year. • reputed company to an on-staff health reputed company and personal trainer. • Many other perks. Apply tot his job Apply To this Job