Staff Dentist Contract Role

6 days ago


Charleston, West Virginia, United States LIBERTY Dental Plan Full time

Transforming Oral Health Care with Excellence

About Us:

LIBERTY Dental Plan is a leading provider of dental benefits, dedicated to delivering exceptional care to our members. We are seeking a highly skilled Staff Dentist to join our team in West Virginia.

Job Summary:

  • As a Staff Dentist, you will play a critical role in ensuring the timely and accurate adjudication of dental claims and prospective requests for dental services.
  • You will be responsible for conducting clinical reviews of claims and pre-authorizations, ensuring compliance with contractual and regulatory requirements.
  • Participate in clinical trainings, calibrations, and Interrater reliability testing to maintain high-quality standards.
  • Collaborate with our team to identify and address potential quality issues and trends in claims submissions.
  • Conduct peer-to-peer calls to discuss utilization trends and quality issues with providers.
  • Participate in Quality Improvement and Provider Credentialing Committees to drive excellence in care delivery.
  • Develop and maintain subject matter expertise in LIBERTY dental benefit plans and applicable state Medicaid programs.
  • Contribute to regulatory reporting and provide input on resolution of member and provider grievances.

Requirements:

  • Minimum DDS/DMD Degree.
  • Active, unrestricted license or certification to practice dental or related health profession in West Virginia in good standing.
  • Minimum 5 years of clinical dentistry experience.

Preferred Qualifications:

  • Demonstrated performance in managing oral health care cost and utilization management.
  • In-depth knowledge of commercial and managed care delivery systems, reimbursement mechanisms, state regulatory and legislative landscape, and quality improvement initiatives.
  • Knowledge of clinical dentistry procedure codes and generally accepted clinical and adjudication guidelines on medical necessity of proposed dental procedures.

What We Offer:

  • A dynamic and supportive work environment.
  • Opportunities for professional growth and development.
  • A competitive compensation package.

Location:

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.


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