Dental Consultant- California

Gainwell Technologies LLC•Any city, OH

22d•$121,700 - $173,800•Hybrid

About The Position

Gainwell Technologies Dental Consultants apply their clinical expertise to review, approve, and/or deny dental treatment authorization requests and claims in accordance with California Department of Health Care Services (DHCS) Medi-Cal Dental policies. Your role in our mission involves reviewing claims, Treatment Authorization Requests (TARs), and related documentation for California Medi-Cal members to support adjudication decisions, ensuring compliance with Medi-Cal Dental policies and procedures. You will collaborate within a team of dental consultants to manage a shared workload of claims requiring the professional expertise of an experienced dentist. These claims are referred by other members of the Claims Processing team, making strong communication and collaboration skills essential to maintaining operational continuity. Additionally, you will assist with the training and onboarding of new dental consultants by providing guidance, mentorship, job shadowing opportunities, and coaching, as needed. You will also provide support to fellow dental consultants by reviewing complex cases and offering second opinions, including collaboration on cases involving special-needs populations served by the Medi-Cal Dental Program. Support will also be provided to other departments, as requested, including: (a) Claims Processing and Operations, (b) Provider and Member Services, (c) Grievances and Appeals, (d) Human Resources, Onboarding, and Interviews, (e) Quality Management, (f) Peer Review, and (g) referrals to and reviews of findings and adjudication related to Clinical Screening Dentist evaluations.

Requirements

Minimum of ten 10 years of hands-on clinical experience practicing dentistry in a general dentistry setting or a recognized dental specialty.
Active (non-expired) license to practice dentistry in California, in good standing and free of any suspensions, restrictions, or sanctions imposed by federal, state, or local regulatory authorities.
Minimum of 2 years of experience working within an organization that provides Medi-Cal Dental services.
Demonstrated expertise and in-depth knowledge of Medi-Cal Dental criteria, policies, and program requirements.

Nice To Haves

Prior experience with adjudication and claims processing for the California Medi-Cal Dental Program is preferred but not required.

Responsibilities

Review claims, Treatment Authorization Requests (TARs), and related documentation for California Medi-Cal members to support adjudication decisions, ensuring compliance with Medi-Cal Dental policies and procedures.
Collaborate within a team of dental consultants to manage a shared workload of claims requiring the professional expertise of an experienced dentist.
Assist with the training and onboarding of new dental consultants by providing guidance, mentorship, job shadowing opportunities, and coaching, as needed.
Provide support to fellow dental consultants by reviewing complex cases and offering second opinions, including collaboration on cases involving special-needs populations served by the Medi-Cal Dental Program.
Support other departments, as requested, including: (a) Claims Processing and Operations, (b) Provider and Member Services, (c) Grievances and Appeals, (d) Human Resources, Onboarding, and Interviews, (e) Quality Management, (f) Peer Review, and (g) referrals to and reviews of findings and adjudication related to Clinical Screening Dentist evaluations.