Advisor Medical Expert - Dental Provider Engagement Specialist

Summary

The Advisor Medical Expert – Dental Provider Engagement Specialist serves as a clinical and operational liaison between Wisconsin Medicaid, its dental provider community, and the dental prior authorization team. The position supports consistent implementation of ForwardHealth dental policy by providing advanced provider education and technical assistance, coordinating dental prior authorization appeals, supporting prior authorization workflows, and identifying opportunities to improve provider experience and program participation.

The position works closely with the Dental Policy Consultant, dentist and dental hygienist/dental therapist adjudicators, professional field representatives, Communications staff, and relevant Wisconsin Medicaid and contractor teams. The role complements the Professional Field Representative function: routine Portal, billing, claims-processing, and general program education should be addressed through established field representative channels, while this position provides escalated dental clinical-policy and prior-authorization support when issues require additional subject-matter expertise.

Your role in our mission

• Serve as an advanced resource for Medicaid dental providers on prior authorizations, documentation, covered services, and ForwardHealth policy.
• Provide escalated technical assistance, provider education, and outreach to support enrollment, participation, compliance, and understanding of program requirements.
• Partner with internal teams to ensure consistent provider communications, address recurring concerns, and represent the dental program at meetings, trainings, conferences, and stakeholder events.
• Guide providers on prior authorization requirements, documentation standards, and coverage criteria.
• Review and adjudicate dental prior authorizations within delegated authority and established policies.
• Support adjudicators through coverage assistance, inventory management, data corrections, workflow coordination, and identification of process improvements.
• Maintain proficiency with systems and tools supporting prior authorization operations.
• Manage administrative workflows for dental prior authorization appeals, including preparation, submission, correspondence, documentation, and deadline compliance.
• Coordinate clinical and policy input as needed and identify appeal trends to support education, operational improvements, and policy clarification.
• Support implementation and operationalization of dental policies, benefits, prior authorization requirements, and documentation standards.
• Collaborate on workflow development, provider education materials, communications, and process improvements.
• Track and analyze provider inquiries, outreach activities, authorization and appeal trends, and participation barriers; provide recommendations and reports to leadership.
• Represent the dental team in operational meetings, maintain knowledge of applicable policies and best practices, and perform other duties within the scope of the role.

What we're looking for

• Required: Current, unrestricted Wisconsin license as a Registered Dental Hygienist (RDH), or other dental professional credential appropriate to the assigned scope of work.
• Substantial clinical dental experience; experience providing care to Medicaid-enrolled or other publicly insured populations strongly preferred.
• Experience with Medicaid, dental benefits administration, prior authorization, dental insurance, provider relations, or public-sector health programs preferred.
• Demonstrated ability to interpret clinical and administrative policy and translate complex requirements into clear, practical guidance for dental providers.
• Knowledge of dental prior authorization, clinical documentation, billing, and claims concepts.
• Strong interpersonal, written, verbal, training, and presentation skills, including the ability to communicate effectively with dental professionals, program staff, and other stakeholders.
• Ability to manage multiple priorities, exercise sound judgment, identify when issues require escalation, and work collaboratively across clinical, policy, operational, and administrative teams.
• Ability to analyze patterns in provider questions, prior authorization activity, and appeals and use those findings to recommend education or process improvements.
• Proficiency with Microsoft Office applications and virtual meeting platforms; ability to learn and effectively use Medicaid claims, document-management, and prior authorization systems.

What you should expect in this role

• Remote opportunity