[Hiring] Staff Dental Consultant @Delta Dental of Michigan

Role Description

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

We celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

The Staff Dental Consultant reviews dental claims and related clinical information to determine medical necessity, appropriateness of care, and benefit eligibility, performing clinical determinations supporting prior authorizations, reconsiderations, appeals, grievances, quality of care reviews, peer-to-peer reviews, and state fair hearings for assigned government programs business.

Qualifications

• D.D.S. or D.M.D. from an accredited school of dentistry
• Current, unrestricted license to practice dentistry
• Five years of clinical dental practice experience
• Previous experience in Medicaid, Medicare Advantage, or dual eligible programs preferred
• Knowledge of the principles and practices of dentistry
• Strong written and verbal communication skills
• Strong interpersonal skills
• Ability to use independent judgment

Requirements

• Knowledge of dental terminology and procedure codes
• Ability to render independent clinical opinions regarding dental conditions, procedures, and treatment
• Ability to review and interpret radiographs and other clinical documentation
• Ability to review and resolve complex clinical and benefit-related issues
• Ability to analyze and resolve highly complex problems

Benefits

• Equal employment and advancement opportunity without regard to protected status

Company Description

Delta Dental of Michigan, Ohio, and Indiana is committed to improving oral health through benefit plans, advocacy, and community support.