Dental Hygienist

NationsBenefits, LLC • Plantation, FL

20d

About The Position

The Dental Hygienist provides clinical expertise supporting claims processing and member and provider services for approximately 400,000 members effective January 1, 2027. The role performs first-level clinical screening of claims, x-rays, periodontal charting, and narratives, and prepares clinical summaries. Fluent clinical dental directors make utilization review recommendations and adverse determinations; the hygienist ensures cases are complete, well documented, and correctly routed.

Requirements

• Graduate of an accredited dental hygiene program.
• Active, unrestricted RDH license in good standing in the United States; state requirement to be confirmed.
• At least 2 years of clinical practice experience.
• Strong knowledge of CDT codes, periodontal classification, radiographic interpretation, and dental benefit concepts.
• Excellent written and verbal communication, analytical skills, and sound judgment.
• Proficiency with Microsoft Office and claims or case management systems.

Nice To Haves

• Dental insurance, claims review, or utilization review experience.
• Experience in a payer or third-party administrator environment.
• Experience with Medicare Advantage or Medicaid dental programs.
• Bachelor’s degree in dental hygiene or a health-related field.
• Bilingual in English and Spanish.

Responsibilities

• Review claims and attachments, including radiographs, periodontal charting, narratives, and intraoral photos, for completeness and consistency with plan clinical policies.
• Triage claims referred by Claims Processors, resolve clinical questions within scope, and escalate cases requiring dental director review to Fluent with a concise clinical summary.
• Coordinate with Fluent on referrals, turnaround, and outcomes; track pending cases and ensure recommendations are applied correctly.
• Support appeals and grievances by preparing clinical case summaries and documentation.
• Serve as a clinical resource to Claims, Customer Service, and Provider Support on CDT codes, treatment sequencing, periodontal and preventive services, and benefit application.
• Train and coach processors on clinical topics such as periodontal staging, radiographic documentation, and code selection.
• Help develop and maintain clinical coverage criteria, claim edits, and reference materials with Fluent and leadership.
• Contribute to quality audits and identify provider billing patterns for referral to compliance or SIU.
• Maintain confidentiality of PHI and comply with HIPAA and applicable state regulations.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree