Asistente Dental - Analista De Reclamaciones

Inmediata Health Group is seeking for a _*Dental Assistant Claims Analyst*_ responsible to manage the claims analysis, determination and processing in accordance with the company policies and procedures and in accordance with operational and financial standards and applicable regulatory requirements.

_*Requirements:*_
* College Degree in Dental Assistant with Expanded Functions
* Dental Assistant with Expanded Functions license in Puerto Rico. (preferred).
* Knowledge in dental coding and billing (preferred)
* Experience in managing healthcare claims processing operations.
* Excellent communication and active listening skills
* Bilingual (English/Spanish) highly preferred

_*Responsibilities:*_
* Analyze claims processing and payment determinations based on plan regulations, quality guidelines and various industry regulations (HIPPA, CMS etc.).
* Ensure quality, accuracy and cost efficiency through the processing of pending claims.
* Maintain effective monitoring of cases assigned to other areas (internal or external) to ensure compliance with the established claims processing time based on standards.
* Report the application of incorrect rates that are not contracted by the Payer that reflect an overpayment in the billed services, irregularities in the rules applied at the allocation system level to ensure quality in the system's automatic processes.
* Contribute to the department in the administration of the determinations of pending claims in catastrophic and chronic cases so that policies and procedures can be developed that facilitate the handling of these types of claims.

Equal Opportunity Employer Minorities/Females/Vets/Disability

Job Type: Full-time

Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
Schedule:
* Monday to Friday



Education:
* Associate (Preferred)

License/Certification:
* Dental Assistant with Expanded Function PR License (Preferred)

Work Location: In person