Dental Auditor

WEST COAST DENTAL ADMINISTRATIVE SERVICES LLC • Artesia, CA

1d • Hybrid

About The Position

The Dental Auditor ensures clinical quality, regulatory compliance, and accurate claims processing across dental plans and provider networks. This role conducts audits and reviews, identifies risks and trends, and partners with internal teams and providers to drive corrective actions and continuous improvement.

Requirements

• Licensed Dentist in California with an active CA dental license.
• CADP-certified auditor (preferred). If not currently certified, must obtain certification promptly upon hire.
• Strong knowledge of dental benefit design, claims workflows, CDT coding, utilization management, and quality improvement principles.
• Excellent analytical, documentation, and report-writing skills; proficiency with audit software and MS Office/Google Workspace.
• Strong communication skills with the ability to deliver clear feedback to providers and cross-functional partners.

Nice To Haves

• Minimum 2 years of experience working with dental plans (payer, DSO, or managed care setting).
• Experience with CADP standards, NCQA-like quality frameworks, or similar accreditation/compliance environments.
• Familiarity with fraud/waste/abuse detection, root cause analysis, and corrective action planning.
• Experience training or educating providers on documentation and coding best practices.

Responsibilities

• Perform clinical and administrative audits of dental records, claims, and utilization to assess compliance with policies, CADP standards, state/federal regulations, and payer requirements.
• Evaluate medical necessity, coding accuracy (CDT), documentation quality, and adherence to evidence-based guidelines.
• Prepare audit reports with findings, risk ratings, corrective action recommendations, and follow-up validation.
• Collaborate with QM, Provider Relations, Compliance, SIU/Anti-Fraud, and Operations to address issues, implement action plans, and monitor outcomes.
• Support readiness for external reviews and accreditation surveys; maintain audit tools, checklists, and SOPs.
• Analyze trends and KPIs (error rates, turnaround times, denial patterns) and present insights to leadership.
• Provide provider education and feedback to improve documentation, coding, and clinical quality.
• Maintain strict confidentiality and data security in accordance with HIPAA and company policies.

What This Job Offers

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