Orthodontic Specialist Consultant

2 weeks ago

Roseville, United States Gainwell Technologies LLC Full time

At Gainwell Technologies, we recognize the importance of exceptional medical professionals in addressing the intricate challenges within the healthcare sector. We invite you to leverage your expertise in innovative ways that you may not have previously considered. While we operate with a sense of urgency, we also prioritize flexibility in work hours, allowing you to maintain a healthy work-life balance. Gainwell offers a rewarding environment where you can advance your career through continuous learning and professional development.

Position Overview

The role of a Dental Consultant at Gainwell Technologies involves utilizing clinical knowledge to assess, approve, or deny requests for dental treatment authorizations and claims, adhering to the guidelines established by the California Department of Health Care Services (DHCS) for the Medi-Cal Dental program. This position is intended for ongoing recruitment.

Your Contributions
  • Evaluate dental documentation to ascertain the medical necessity of orthodontic services, ensuring compliance with established standards of care.
  • Process Treatment Authorization Requests (TARs), Notices of Authorization (NOAs), and Claim Inquiry Forms (CIFs) manually, following the protocols set by the CA Department of Health Care Services (DHCS) to guarantee compliance with Medi-Cal Dental policies.
  • Collaborate with a team of dental consultants, including fellow orthodontists, to manage a balanced workload of prior authorizations and claims that require the expertise of seasoned orthodontic professionals. Strong communication skills are essential for seamless business operations.
  • Support the training and onboarding of new dental consultants, offering mentorship and guidance, including assistance with complex cases and claims.
  • Provide assistance to other departments as needed, including Claims Processing, Provider and Member Services, Grievances/Appeals, HR/Onboarding, Quality Management, and Peer Review.
Qualifications
  • A minimum of ten (10) years of direct clinical experience as an Orthodontic Specialist providing dental services. Candidates must be recognized specialists in Orthodontics and fulfill all requirements set by the Board of Dental Examiners in California.
  • Possession of an active, unexpired license to practice dentistry in California, in good standing, free from any suspensions or sanctions.
  • Experience with adjudication and claims processing for the Medi-Cal Dental Program in California is advantageous but not mandatory.
  • Comprehensive knowledge of Medi-Cal Dental criteria and program requirements.
  • Must hold a valid Orthodontist designation.
Work Environment
  • This position offers a hybrid work model, requiring two days on-site and three days remote.
  • Full-time commitment of 40 hours per week with a competitive salary and benefits package.
  • To effectively work remotely, employees should have a broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload.
  • Ensure that the address provided in your application is a physical location for equipment delivery.

The salary range for this position is $116,000 per year, with variations based on geographic location, internal equity, and individual qualifications. Gainwell is committed to providing a flexible work environment, generous vacation policies, a 401(k) employer match, comprehensive health benefits, and educational support. We also offer various leadership and technical development programs to enhance your skills.

At Gainwell Technologies, we believe in the power of collaboration, innovation, and inclusion to drive growth and improve healthcare for all. Explore more about Gainwell and our career opportunities on our website.

Gainwell Technologies is dedicated to fostering a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, ensuring that all qualified applicants receive fair consideration for employment without regard to race, religion, color, national origin, gender, sexual orientation, gender identity, age, disability, or other legally protected characteristics.

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