Dental PA Review Hygienist Consultant- Wisconsin

Gainwell Technologies LLC•Any city, OH

4d•$64,500 - $92,200•Remote

About The Position

The Dental PA Review Hygienist Consultant will review Medicaid Prior Authorizations based on medical necessity in accordance with State policy guidelines, provide guidance and support for Medicaid Providers when appropriate, and act as a clinical SME (or liaison) for internal Gainwell entities. This is not a patient-facing position.

Requirements

Current Dental Hygiene license in the state of WI (or license from another state and ability to obtain WI license prior to position start date).
Extensive experience in the Dental field, including knowledge of CDC codes as well as ForwardHealth Policy requirements for related codes.
Knowledge of and/or experience working with the Wisconsin Medicaid program (or other state’s Medicaid programs)
Excellent interpersonal, oral, and written communication skills.
Ability to meet deadlines and manage priorities with minimal direct supervision.
Experience working with various partners or team members toward shared goals.
Ability to communicate effectively and interpret policies and procedures.

Responsibilities

Reviewing member Dental Histories and occasionally Adjudicating Dental prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted dental practices.
Reviewing and evaluating prior authorization submissions utilizing multiple computer systems, and when appropriate seeking additional information or clarification from requesting Provider.
Completing prior authorization adjudication into the Medicaid Management Information System (MMIS) for processing.
Participation in monthly meetings which include Gainwell leadership, operational staff support, clinical peers, and State stakeholders.
Providing assistance and education to the provider community related to specific prior authorization submissions, when applicable.
Working alongside the Dental team to ensure timely adjudications of Dental Prior Authorization requests.
Review communications to providers and members on new/revised policies.