Dental Consultant (TAR) - Roseville, CA
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About The Position
Gainwell Technologies Dental Consultants (Dentist) apply clinical expertise to review, approve, and/or deny dental treatment authorization requests and claims in accordance with CA Department of Health Care Services (DHCS) Medi-Cal Dental policies. Your role in our mission includes reviewing dental records to determine medical necessity of oral health services within professionally recognized standards of care, manually adjudicating Treatment Authorization Requests (TARs), Notices of Authorization (NOAs) and Claims utilizing standards and procedures set forth by the CA Department of Health Care Services (DHCS) to ensure adherence to Medi-Cal Dental policies and procedures. You will work within a team of dental consultants, sharing a proportional workload of prior authorization and/or claims processing that have been determined to need professional expertise. Good communication skills are necessary for continuity within the business operations. When needed, dental consultants assist with training and orientation of new dental consultants, providing guidance and mentoring, such as job coaching and peer interaction including assistance with complex cases or claims. Additionally, you will assist other departments when requested, including Claims Processing and Operations, Provider and Member Services, Grievances/Appeals, HR/Onboarding/Interviews, Quality Management, Peer review, and providing findings to the claims processing team and/or adjudication of claims.
