Dental Consultant - Prior Authorization/Special Claims Review Dentist (Roseville, CA)

Date: Nov 12, 2024

Location:

Roseville, CA, US, 95747-6645

Req ID: 27756

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 Consultant (Dentist) for Prior Authorization / Special Claims Review (PA/SCR) within is responsible for supporting activities to detect and report potential fraud, abuse and quality of care issues within the Medi-Cal Dental Program as a part of Compliance Management. This role serves to help maintain the integrity of the Program. You will play a vital role in identifying areas for improvement and assisting in implementing strategies to enhance Program performance.

Your role in our mission

Reviews and processes treatment authorization requests (TARs) and claims for Medi-Cal Dental Providers on utilization control/sanctions
Communicates with and provides guidance for Providers placed on utilization control
Works closes with the Department of Health Care Services (DHCS) to identify and review Provider training and recommendations for provider removal from utilization control.
Assist in reviewing and analyze the delivery, billing, and utilization of services on a case-by-case basis, to detect unusual practices, billing anomalies and potential abuse by Medi-Cal providers and/or members
Communicate and present billing trends and findings to team members and DHCS

What we're looking for

A minimum of ten (10) years of experience as a dentist. Must hold an active CA dental license, in good-standing and free of any suspensions or sanctions from Federal, State or local jurisdictions.

Proficiency in creating, querying, and analyzing reports
Strong writing skills with the ability to convey data in a clear and actionable manner
Demonstrated expertise and knowledge of Medi-Cal Dental criteria and clinical screening preferred.
Position is hybrid (Roseville, CA), 2 days per week

What you should expect in this role

This is a part-time permanent regular salaried (W-2) employee position.
- Monday through Friday work schedule (20 hours per week).

Computer for work company provided.
For all hybrid 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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The pay range for this position is $116,000 - $165,000 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.