Dental Consultant (Claims Adjudication)

Date:  Feb 21, 2024
Location: 

Roseville, CA, US, 95747-6645

Req ID:  18812

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

 

Summary

As a Dental Consultant at Gainwell Technologies, you will contribute to a healthier community by manually reviewing claims and Treatment Authorization Requests (TARs) for California Medi-Cal members. Work collaboratively with a team of dental consultants, adjudicating claims and providing expertise as needed. Assist in training new consultants, mentor colleagues, and collaborate on complex cases. Extend support to various departments when required. As a Dental Consultant, leverage technology to enhance health outcomes and be part of a team dedicated to innovative healthcare solutions.

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 the professional expertise of an experienced dentist. These claims have been referred by 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 the 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) Clams 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/adjudications 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 an 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 Program in California is a plus but not a requirement.
  • Demonstrated expertise and knowledge of Medi-Cal Dental criteria and program requirements.

What you should expect in this role

 

  • Must be a resident of the state of California.
  • Hybrid work environment 3 days a week in the office as needed for face-to-face and client meetings with the remainder of the time remote work.
  • Office is located in Roseville, CA.

 

 

The pay range for this position is $116,100.00 - $165,900.00 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.