Reviewing Dentist

Our client is looking for a Reviewing Dentist who will be responsible for maintaining a set clinical review schedule of 32 hours per week (hours between 6am-7pm PST 4 days/week), with expected 24-48-hour turnaround time for items available for clinical review and peer to peer phone calls.

This is a mobile (fully remote) position with set days and hours.

You will:

• Provide clinical review of predeterminations, claims, and/or appeals by accurately reviewing radiographs and/or other diagnostic information to determine claim decision in accordance with Client clinical guidelines. May also include other responsibilities, such as completion of assigned Peer to Peer calls, participation in panel review of clinical determinations, completion of Clinical Grievance reviews, and participation in credentialing meetings

• Be responsible for maintaining quality work ensuring that review determinations are sound and supported by the diagnostic materials submitted and in accordance with Client Clinical Policies. Success in this role will be measured based on a combination of production and quality metrics

• Support implementation of any new clinical review policy/criteria recommended by Dental Officer, Dental Standards & Quality Management and maintain awareness of continuous updates as pertaining to clinical review

You have:

• Degree from ADA approved dental school

• Minimum 10 years clinical practice

• Licensed dentist in a minimum of one state

• Demonstrated communication skills

• Proven computer skills with proficiency in Windows-based programs; including, but not limited to Outlook, Teams, Internet Explorer, and Chrome

• In-depth knowledge of CDT codes, procedures, and dental insurance concepts

• Strong knowledge of Client dental clinical policies and guidelines, preferred

• Ability to manage multiple workloads with multiple deliverables

• Experience adapting to changing business priorities and environments