Clinical Reviewer, Dental Hygienist

Devoted Health • Waltham, MA

5d • $58,000 - $75,000 • Remote

About The Position

A licensed dental hygienist on Devoted Health’s Clinical Operations team performs first-level clinical reviews of dental claims and pre-treatment estimates using established clinical guidelines, policies, and delegated authority. The role supports accurate, timely, and compliant utilization management, high-quality and compassionate care, and strong relationships with dental providers.

The position follows a five-day, eight-hour schedule totaling 40 hours per week. Shifts are scheduled between 8:00 AM and 8:00 PM ET and include rotating weekend and holiday coverage. The reviewer evaluates dental documentation and images, applies coding and policy requirements, records findings in claims systems, and refers complex cases and potential denials to Dental Advisors or other designated clinical authorities for final determination. The reviewer does not deny authorizations.

The role works with Dental Advisors, Claims, Provider Relations, and team leads, and is responsible for following HIPAA, privacy standards, organizational policies, and regulatory requirements. The posted annual salary range is $58,000–$75,000. The position is remote, as indicated by the remote listing tag.

Requirements

• At least 5 years of clinical experience as a dental hygienist in a private practice or comparable dental healthcare setting.
• Active Registered Dental Hygienist (RDH) license or relevant clinical dental credential in good standing.
• Strong working knowledge of ADA CDT coding, dental terminology, dental procedures, and clinical documentation.
• Ability to read and interpret dental radiographs, charting, clinical narratives, and treatment records.
• Excellent analytical, organizational, communication, and problem-solving skills, with high attention to detail.
• Proficiency with claims-processing systems, electronic health or dental records, and standard digital tools.
• Experience with technology-enabled workflow improvements, particularly AI/LLM tools.

Nice To Haves

• Dental claims review or utilization management experience.
• Prior experience in dental insurance claims review, utilization management, or health plan clinical operations, ideally within a Medicare Advantage or managed care setting.

Responsibilities

• Review assigned dental claims and pre-treatment estimates requiring clinical evaluation, approving claims that meet clinical, contractual, and documentation requirements.
• Evaluate radiographs, dental charting, narratives, treatment records, and claim histories using evidence-based guidelines and clinical expertise.
• Refer complex cases, potential denials, or adverse benefit determinations to Dental Advisors or designated clinical authorities for final determination; the reviewer does not deny authorizations.
• Identify required documentation for clinical review, provide clear processing instructions, and accurately document review findings in claims systems.
• Apply ADA CDT coding knowledge, dental terminology, clinical documentation standards, and contractual provisions consistently.
• Identify and escalate unusual practice patterns, utilization trends, potential fraud, waste, or abuse concerns, policy gaps, and workflow issues.
• Collaborate with Dental Advisors, Claims, Provider Relations, and team leads to support smooth operations and constructive provider communications.
• Maintain compliance with HIPAA, privacy standards, organizational policies, and regulatory requirements.

Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• Bonus eligibility for all roles excluding Director and above; commission eligibility for Sales roles.
• Parental leave program.
• 401(k) program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed