Gainwell Technologies is seeking experienced Dental Consultants specializing in Orthodontics to leverage their clinical knowledge in evaluating and processing dental treatment requests and claims. This role is essential for ensuring compliance with Medi-Cal Dental policies.

• Assess dental documentation to ascertain the medical necessity of orthodontic interventions based on established standards of care.
• Execute manual adjudication of Treatment Authorization Requests (TARs), Notices of Authorization (NOAs), and Claim Inquiry Forms (CIFs) in alignment with the guidelines provided by the CA Department of Health Care Services (DHCS).
• Collaborate with a team of dental professionals, including fellow orthodontists, to manage a balanced workload of prior authorizations and claims processing requiring specialized orthodontic expertise.
• Provide mentorship and training to new dental consultants, offering support in complex cases and claims through job coaching and peer interaction.
• Assist various departments as needed, including Claims Processing, Provider Services, and Quality Management, contributing findings to enhance operational efficiency.

• A minimum of ten (10) years of direct clinical experience as an Orthodontic Specialist.
• Active and valid dental license in California, in good standing without any disciplinary actions.
• Familiarity with Medi-Cal Dental Program adjudication and claims processing is advantageous.
• In-depth understanding of Medi-Cal Dental criteria and requirements.
• Must hold a recognized Orthodontist qualification.

• This position operates in a hybrid model, requiring two days on-site and three days remote work.
• Full-time commitment of 40 hours per week with a comprehensive benefits package.
• Candidates must have a reliable broadband internet connection to facilitate effective teleworking.

The compensation for this role is competitive, reflecting the experience and expertise of the candidate. Gainwell Technologies values flexibility, professional growth, and a supportive work environment, offering a range of benefits including a flexible vacation policy, 401(k) matching, health coverage, and educational support.

Gainwell Technologies is dedicated to fostering a diverse and inclusive workplace. We are an Equal Opportunity Employer, ensuring that all qualified candidates receive fair consideration without discrimination based on various protected characteristics.