Hybrid Senior Clinical Dental Consultant

Posted 8 hours ago

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About the role

  • Reviews claims based on medical necessity, in accordance with market contracts
  • Evaluate appeals and identify if proper documentation has been obtained to deny claim
  • Makes further recommendations, request additional information, review charts, and make revised or reiterate claim decision
  • Reviews authorization requests for anesthesia and rendering judgement on medical necessity
  • Review and render conclusions on all orthodontic claims for handicapping malocclusions specific to each Market contract
  • Communicate claim review outcome to participating Dentists, plan members, and Health Plans
  • Facilitate and give Provider orientations
  • Communicate to management ways to improve processes and productivity of company
  • Develop a full comprehension of the administration of the dental program, including, but not limited to: benefit and authorization requirements for Plans and/or States
  • Develop knowledge and understanding of state and federal dental regulations, and proactively alert staff of changes that are taking place
  • Provide guidance and education in the provider community on the dental program; provide recommendations in managing the dental program efficiently and effectively
  • Represent the company in a professional manner for the market, including meetings associated with the provider community
  • Proactively seek out opportunities to speak on the benefits of Medicaid and Medicare dental programs
  • Identify community opportunities for the company to participate within, including, but not limited to: health fairs, dental screenings, back to school programs, etc.
  • Develop an understanding of the oral health wellness and outreach programs offered, working closely with Dental Consultants and staff
  • Review dental cases to represent the company at fair hearings, as needed
  • Establish relationships with dental associations and key stakeholders in the surrounding region, helping to solidify new business in other states
  • Adhere to business processes
  • Recruit qualified providers for the network
  • Other duties as assigned

Requirements

  • Graduate of an accredited Dental School (D.D.S. or D.M.D)
  • Orthodontic experience a plus
  • Maintain an unrestricted dental license
  • Knowledge of general dentistry
  • Efficient PC skills
  • Ability to use analytical/presentation tools such as Excel and PowerPoint
  • Organizational and time management skills
  • Ability to work with a team and independently to complete assigned tasks without supervision
  • Ability to make independent determinations on all types of dental claims
  • Excellent written and verbal communication skills
  • Ability to distinguish between multiple market benefits
  • Ability to prioritize and organize multiple tasks
  • Ability to remain organized with multiple interruptions
  • Networking and Negotiation skills required
  • Ability to travel as needed
  • Required to attend additional training as requested/deemed necessary

Benefits

  • Generous vacation and sick time
  • Market-leading paid family, parental and adoption leave
  • Medical coverage
  • Company paid life and AD&D insurance
  • Disability programs
  • Partially paid sabbatical program
  • 401(k) employer match
  • Stock purchase options
  • Employer-funded retirement account
  • Flexible, inclusive and collaborative work environment

Job title

Senior Clinical Dental Consultant

Job type

Experience level

Senior

Salary

$130,800 - $196,200 per year

Degree requirement

Professional Certificate

Location requirements

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