[Hiring] Dental Consultant Reviewer @COMAGINE HEALTH

Role Description

This is a PRN (on-call) position with a typical workload of 6 hours per week. The Dental Consultant Reviewer plays a critical role in ensuring the quality and accuracy of dental care services within the healthcare system.

• Thorough review and evaluation of dental claims, treatment plans, and clinical documentation to verify compliance with established guidelines and standards.
• Collaboration with dental professionals and healthcare providers to provide expert recommendations and support decision-making processes.
• Identification of discrepancies, potential fraud, or unnecessary procedures to help optimize patient care and resource utilization.
• Contributes to maintaining high standards of dental care and supports the integrity of healthcare services in the Washington DC area.

Qualifications

• Current, active, unrestricted clinical licensure D.C. Washington Dental Hygienist (RDH)
• AA/AS in a related field
• Graduation from an accredited school of Dental Hygiene
• District of Columbia Registered Dental Hygienist
• Strong knowledge of dental coding systems (e.g., CDT codes) and insurance claim processes.
• Familiarity with healthcare compliance standards and regulatory requirements related to dental services.
• Excellent analytical and communication skills to assess clinical information and interact with providers.

Requirements

• Experience in dental consulting, claims review, or utilization management within a healthcare or insurance setting.
• Certification in dental coding or healthcare compliance.
• Advanced training or specialization in dental public health, oral surgery, or orthodontics.
• Proficiency with electronic health records (EHR) and dental practice management software.
• Prior experience working in a multidisciplinary healthcare environment.

Responsibilities

• Review and analyze dental claims and clinical documentation for accuracy, completeness, and compliance with regulatory and organizational standards.
• Evaluate treatment plans and procedures to ensure they are medically necessary and align with best practices in dental care.
• Collaborate with dental providers and healthcare teams to clarify information, resolve discrepancies, and provide expert guidance.
• Prepare detailed reports and recommendations based on case reviews to support claims adjudication and quality assurance processes.
• Stay current with dental industry regulations, coding standards, and clinical advancements to inform review practices.

Skills

The Dental Consultant Reviewer utilizes clinical expertise and analytical skills daily to assess the validity and necessity of dental treatments and claims.

• Strong communication skills for effectively collaborating with dental providers and healthcare teams to resolve clinical questions and discrepancies.
• Attention to detail and critical thinking to identify potential errors, fraud, or inefficiencies in documentation and billing.
• Familiarity with dental coding and regulatory standards to ensure accurate interpretation and application of guidelines during reviews.
• Proficiency with digital tools and software to support efficient management of case files and reporting.