Director of Clinical Audits and Peer Reviews

North American Dental Group•Pittsburgh, PA

51d

About The Position

We are looking for a Director of Clinical Audits and Peer Reviews to join our compliance team. This individual will report to the Compliance Director and assist the Compliance Department in developing and executing a comprehensive clinical audit and peer review strategy aligned with organizational quality and compliance goals.

Requirements

At least eight (8) to ten (10) years experience of in a clinical dental environment
Comprehensive knowledge of dental procedures and CDT coding
Understanding of insurance billing practices and documentation requirements
Knowledge of state Dental Practice Acts and scope of practice for dental healthcare personnel (DHCP)
Ability to analyze audit findings and provide actionable recommendations
Ability to interpret radiographic images
Working knowledge of clinical dentistry across specialties
Understanding of standard of care and risk exposure
Knowledge of CDC and ADA infection control guidelines
Knowledge of OSHA Bloodborne Pathogen (BBP) Standard and workplace safety requirements
Understanding of best practices for sterilization, disinfection, and dental operatory setup
Knowledge of regulatory compliance requirements and inspection readiness
Strong presentation and communication skills
Proficiency in Open Dental (OD) reporting and MS Office, especially PowerPoint, Word and Excel
Attention to detail; very organized
Ability to interact with people at all levels of the corporate structure, prioritize and handle numerous competing demands in a high-volume, fast-paced working environment
Ability to work independently and complete job responsibilities without significant oversight

Responsibilities

Conduct internal audits, peer audits, and internal investigations
Manage and respond to external audits (insurance companies, regulatory agencies, state dental boards, legal entities)
Oversee external insurance payment audits
Identify compliance risks and implement corrective action plans
Present compliance workflows and documentation standards
Design and select procedures for peer audit review
Train and educate auditors on audit protocols and software tools
Analyze peer audit results and present findings to clinical leadership
Facilitate follow-up and resolution of issues identified during audits
Participate in clinical review of patient and internal complaints
Support investigations involving clinical care and documentation
Work with Quality Assurance Committee of the Oral Health Board to address issues identified during clinical reviews
Participate in Credentialing committee workflows and meetings for clinical review of re-credentialling matters
Serve as expert for state and federal dental practice act regulations, including allowable and prohibited duties by clinical role
Oversee infection control compliance across supported practices
Monitor Direct Unit Water Line (DUWL) testing and weekly spore testing completion
Troubleshoot sterilization and testing issues with offices
Provide guidance on sterilization, disinfection, and PPE standards
Provide onboarding education for new hires
Deliver ongoing training on compliance, infection control, and vendor tools
Support adoption of organizational protocols and best practices
Monitor key performance indicators (KPIs) related to audits and infection control
Prepare and deliver quarterly reports to executive leadership
Collaborate with executive and operational leadership, including the Chair of the Oral Health Board, Vice Presidents of Operations and Clinical Operations, and Regional Directors of Operations.
Advocate for company-wide clinical standards