Hybrid Dental Consultant (Clinical Screening and Compliance)
JOB TITLE:
Hybrid Dental Consultant (Clinical Screening and Compliance)
JOB LOCATION:
3 days a week onsite in Roseville CA
WAGE RANGE :
$120k to $140k
JOB NUMBER:
21016
REQUIRED
Experience:
Dentist
Medi-Cal
JOB DESCRIPTION
Equal Opportunity Employer Veterans/Disabled
While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to:
job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions.Estimated Salary: $20 to $28 per hour based on qualifications.
Hybrid Dental Consultant (Clinical Screening and Compliance)
JOB LOCATION:
3 days a week onsite in Roseville CA
WAGE RANGE :
$120k to $140k
JOB NUMBER:
21016
REQUIRED
Experience:
Dentist
Medi-Cal
JOB DESCRIPTION
Client Dental Consultants apply clinical expertise to review, approve, and/or deny dental treatment authorization requests and claims in accordance with CA Department of Health Care Services (DHCS) Medi-Cal Dental policies.
Your role in our mission
- Manually review of claims, Treatment Authorization Requests (TARs) and related documents for California Medi-Cal members for adjudication, ensuring adherence to Medi-Cal Dental policies and procedures.
- Work within a team of dental consultants, sharing a proportional workload of claims processing and adjudication that have been determined to need professional expertise of an experienced dentist. These claims have been referred from other members of the Claims Processing team, and good communication skills are necessary for continuity within the business operations.
- When needed, dental consultants assist with training and orientation of new dental consultants, providing guidance and mentoring, such as job shadowing and coaching.
- Assist fellow dental consultants with complex cases or claims needing a second opinion, including collaboration for cases involving Medi-Cal Dental Program special needs populations.
- Assist other departments, when requested:
a) Claims Processing and Operations, b) Provider and Member Services, c) Grievances/Appeals, d) HR/Onboarding/Interviews, e) Quality Management, f) peer review, and g) referral to/review of findings/adjudication of claims related to Clinical Screening dentist evaluations.
What we're looking for
- A minimum of ten (10) years of prior hands-on, clinical experience as a dentist delivering dental services within a general or recognized dental specialty practice.
- Possession of active (non-expired) license to practice dentistry in CA, which is in good-standing and free of any suspensions or sanctions from Federal, State, or local jurisdictions.
- Minimum of two (2) years working within an organization that provides Medi-Cal Dental services to patients. Prior adjudication and claims processing for the Medi-Cal Dental Program in California is a plus, but not a requirement.
- Demonstrated expertise and knowledge of Medi-Cal Dental criteria and program requirements.
- Position will be required to be On-site (Roseville, CA), with possible Hybrid schedules (Tuesday -Thursday in office).
Equal Opportunity Employer Veterans/Disabled
While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to:
job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions.Estimated Salary: $20 to $28 per hour based on qualifications.
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