UnitedHealth Group Clinical Fair Hearings and Appeals - RDH - Brooklyn, NY in Brooklyn, New York
In collaboration with and supervision by the Registered Dental Hygienist (RDH) Manager and the National Dental Director, the Fair Hearing Appeals RDH, is responsible for providing recommendations for clinical case outcomes determined by a licensed dentist. The Fair Hearing (FH) RDH will attend and represent UnitedHealthcare (UHC) in all Brooklyn Court appearances. Primary Responsibilities: Work as part of an integrated team of the QA team, other functional areas, and members of the UHC C&S Medical appeals staff Receive, gather information, and prepare Fair Hearing packets for the NY C&S Health Plan and others as appropriate for clinical and administrative determinations Communicate with UHC RDH manager and dental directors regarding Fair Hearings Works directly with DDS making the final determination on Clinical cases Attends the Brooklyn Fair Hearings in person and represents UHC. Counsels and educate members and providers regarding adverse determinations and plan benefits Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, and staff training as appropriate Participating in organizational committees, projects, and task forces as appropriate Prepare Evidence packets; collect & compile supporting documentation to support adverse determination and make 3 copies for hearing Prepare waiver packets Travel to & Present evidence packet at Fair Hearings in court Receive Decision & Orders (D&O) from NYS and update outcome status in tracking log Review D &O; Coordinate implementation of directives from Administrative Law Judge Receive compliance inquiries from NYS requesting proof of compliance with D&O Coordinate and compile proof of compliance and draft responses to NYS DOH C&S Dental Medicaid Fair Hearings in-person representation in the Brooklyn Courthouse, as required by the State - This will reduce dental consultant costs, and allow for increased oversight and management of the revised and improved process Required Qualifications: Registered Dental Hygienist (RDH) with an active, unrestricted license 5 + years clinical practice experience 2+ years of Healthcare or Managed Care experience 2+ years of experience with Microsoft Office (Excel, Word, PowerPoint) Excellent verbal and written communication skills Ability to travel to multiple counties to attend Fair Hearings (Brooklyn County, Nassau County, Suffolk County and Westchester County) Knowledge of NY State Medicaid Dental Regulations Intermediate presentation skills for both clinical and non-clinical audiences Ability to manage multiple tasks and due dates. Preferred Qualifications: Experience with claims coding and review Familiarity with current dental issues and practices Internet researching skills Careers with UnitedHealthcare.
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It's where you can do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace.
Candidates are required to pass a drug test before beginning employment. Job Keywords: Keywords: RDH, Dental Hygiene, Hygienist, Appeals, Fair hearing, Dental Appeals, Managed Care, FH, New York Regulations 1c030625-8e6c-4b82-b30b-eb38fcee897b
Clinical Fair Hearings and Appeals - RDH - Brooklyn, NY New York-Brooklyn 725520