- Review dental records to determine medical necessity of oral maxillofacial surgery (OMS) services within professionally recognized standards of care.
- Manually adjudicate Treatment Authorization Requests (TARs), Notices of Authorization (NOAs) and Claim Inquiry Forms (CIFs) utilizing standards and procedures set forth by the CA Department of Health Care Services (DHCS) to ensure adherence to Medi-Cal Dental policies and procedures.
- Works within a team of dental consultants, including other OMS, sharing a proportional workload of prior authorization and/or claims processing that have been determined to need professional expertise of an experienced OMS. These claims have been referred from other members of the Claims Processing team, usually involving special needs patients, and good communication skills are necessary for continuity within the business operations.
- When needed, OMS dental consultants assist with training and orientation of new dental consultants, providing guidance and mentoring, such as job coaching and peer interaction including assistance with complex cases or claims.
- Assists 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) Providing findings to the claims processing team and/or adjudication of claims related to OMS cases.
- A minimum of ten (10) years of prior hands-on, clinical experience as an OMS Specialist delivering dental services. The candidate must be a recognized Specialist in OMS and meet all requirements and training set forth by the Board of Dental Examiners in California.
- 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.
- Prior adjudication and claims processing for the Medi-Cal Dental Program in California is a plus, but not a requirement.
- Expertise and knowledge of Medi-Cal Dental criteria and program requirements.
- Must be an oral surgeon.
- Position is hybrid, meaning you will work in the Roseville, CA office each Tuesday through Thursday and at home on Monday and Friday.
- Full-time Monday through Friday (40 hours per week) salaried employee position.
- 8 AM to 5 PM schedule.
- Health benefit (medical, dental, and vision) package available on first day of employment.
- Discussed in detail during new hire orientation after first day of work.
- In order to effectively work as a teleworker with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
- To Test your internet download and upload speed:
- Go to Google
- Search for Internet Speed Test.
- Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
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Dental Consultant - Roseville, United States - Gainwell Technologies LLC
Description
It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
Gainwell Technologies 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
What we're looking for
What you should expect in this role
#LI-NB1
#LI-HYBRID
This position is intended for pipelining. We will accept applications on an ongoing basis.
The pay range for this position is $116,100 - $165,900 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.
