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Dental Consultant

3 months ago

Roseville, United States Gainwell Technologies LLC Full time

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

**Summary**:
**Your role in our mission**:

- Manually review of claims, Treatment Authorization Requests (TARs) and related documents for California Medi-Cal members for adjudication, ensuring adherence to Medi-Cal Dental policies and procedures.
- Work within a team of dental consultants, sharing a proportional workload of claims processing and adjudication that have been determined to need professional expertise of an experienced dentist. These claims have been referred from other members of the Claims Processing team, and 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 shadowing and coaching.
- Assist fellow dental consultants with complex cases or claims needing a second opinion, including collaboration for cases involving Medi-Cal Dental Program special needs populations.
- Assist other departments, when requested: a) Claims Processing and Operations, b) Provider and Member Services, c) Grievances/Appeals, d) HR/Onboarding/Interviews, e) Quality Management, f) peer review, and g) referral to/review of findings/adjudication of claims related to Clinical Screening dentist evaluations.

**What we're looking for**:

- A minimum of ten (10) years of prior hands-on, clinical experience as a dentist delivering dental services within a general or recognized dental specialty practice.
- Possession of active (non-expired) license to practice dentistry in CA, which is in good-standing and free of any suspensions or sanctions from Federal, State, or local jurisdictions.
- Minimum of two (2) years working within an organization that provides Medi-Cal Dental services to patients. Prior adjudication and claims processing for the Medi-Cal Dental Program in California is a plus, but not a requirement.
- Demonstrated expertise and knowledge of Medi-Cal Dental criteria and program requirements.
- Willingness to travel if needed

**What you should expect in this role**:

- This is a hybrid position.
- Commuting and travel costs are not paid by Gainwell.
- Full-time (40 hours per week) salaried employee status with pay twice a month.
- No probationary period. Regular employee status on first day of work.
- Career growth training and opportunities.
- Company computer provided.
- Benefits starting on first day of employment.
- Paid Time Off (vacation, holidays, and sick time)
- Health benefits (medical, dental, vision)
- You must be available to work Monday through Friday between 8 AM to 5 PM to work a total of 8 hours per day.
- In order to effectively work as a remote employee with Gainwell each Monday and Friday, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
- To Test your internet download and upload speed:

- Go to Google
- Search for Internet Speed Test or click here.
- Internet services are not covered by Gainwell.
- Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.

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We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
- Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees._