Dental Consultant (TAR) - Roseville, CA

Gainwell Technologies • Roseville, CA

404d • $121,700 - $130,000 • Remote

About The Position

Gainwell Technologies is seeking a Dental Consultant (Dentist) to apply clinical expertise in reviewing, approving, and denying dental treatment authorization requests and claims in accordance with California's Medi-Cal Dental policies. This role involves working collaboratively within a team to ensure adherence to standards of care and providing guidance to new consultants. The position offers flexibility in work hours and the opportunity for career growth in a supportive environment.

Requirements

• A minimum of ten (10) years of hands-on clinical experience as a dentist.
• Possession of an active, non-expired license to practice dentistry in California in good standing.
• Knowledge of Medi-Cal Dental criteria and program requirements is essential.
• Prior adjudication and claims processing experience for Medi-Cal Dental is a plus.

Nice To Haves

• Experience with special needs patients.
• Strong communication skills for continuity in business operations.

Responsibilities

• Review dental records to determine medical necessity of oral health services.
• Manually adjudicate Treatment Authorization Requests (TARs), Notices of Authorization (NOAs), and Claims according to Medi-Cal Dental policies.
• Collaborate with a team of dental consultants to manage prior authorization and claims processing workloads.
• Assist in training and mentoring new dental consultants, including job coaching and support with complex cases.
• Provide assistance to other departments as needed, including Claims Processing, Provider and Member Services, and Quality Management.

Benefits

• Health (medical, dental, vision) benefits starting on day 1 of employment.
• Paid time off benefits starting on day 1 of employment.
• 401(k) company match available within months of starting.
• Flexible vacation policy.
• Educational assistance and professional development opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Professional, Scientific, and Technical Services
• Education Level: No Education Listed