Dental Consultant (Orthodontist) - Roseville, CA

Summary

Gainwell Technologies Dental Consultants (Orthodontist) 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

• Review dental records to determine medical necessity of orthodontic services within professionally recognized standards of care and Medi-Cal Dental criteria.
• Review and 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.
• Work within a team of dental consultants, including other orthodontists, sharing a proportional workload of prior authorization and/or claims processing that have been determined to need professional expertise of an experienced orthodontist.
• 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 Orthodontic cases.

What we're looking for

• A minimum of ten (10) years of prior hands-on, clinical experience as an Orthodontic Specialist delivering dental services. The candidate must be a recognized Specialist in Orthodontics 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 historical or current suspensions or sanctions from Federal, State, or local jurisdictions.
• Prior adjudication and claims processing for the Medi-Cal Dental Program in CA is a plus, but not a requirement.
• Expertise and knowledge of Medi-Cal Dental criteria and program requirements.
• Position will be temporarily remote within California and switched to On-Site (Roseville, CA) as needed, to be determined. 

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
  • Monday through Friday work schedule (8 hours per day totaling 40 hours per week).
• Upward career advancement is possible and encouraged.
• Health (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• Computer for work company-provided.
• For all hybrid and remote positions 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.
• This position is intended for pipelining. We will accept applications on an ongoing basis.

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