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Orthodontic Specialist Consultant
2 months ago
Gainwell Technologies is seeking experienced Orthodontic Consultants to leverage their clinical expertise in evaluating and processing dental treatment authorization requests and claims in compliance with Medi-Cal Dental policies. This role is designed for ongoing recruitment, welcoming applications continuously.
Your Contribution to Our Mission- Analyze dental documentation to assess the medical necessity of orthodontic interventions based on established standards of care.
- Process Treatment Authorization Requests (TARs), Notices of Authorization (NOAs), and Claim Inquiry Forms (CIFs) manually, adhering to the guidelines set by the CA Department of Health Care Services (DHCS) to ensure compliance with Medi-Cal Dental regulations.
- Collaborate with a team of dental consultants, including fellow orthodontists, sharing responsibilities for prior authorization and claims processing that require the specialized knowledge of an experienced orthodontist. Effective communication is essential for seamless business operations.
- Support the training and onboarding of new dental consultants, offering mentorship and guidance, including assistance with complex cases or claims.
- Provide assistance to other departments as needed, including Claims Processing, Provider and Member Services, Grievances/Appeals, HR/Onboarding, Quality Management, and peer review, while sharing findings with the claims processing team regarding orthodontic cases.
- A minimum of ten (10) years of hands-on clinical experience as an Orthodontic Specialist delivering dental services. Candidates must be recognized specialists in Orthodontics and meet all requirements set by the Board of Dental Examiners in California.
- An active (non-expired) license to practice dentistry in California, in good standing, without any suspensions or sanctions.
- Experience in adjudication and claims processing for the Medi-Cal Dental Program in California is advantageous but not mandatory.
- In-depth knowledge of Medi-Cal Dental criteria and program requirements.
- Must be a qualified Orthodontist.
- This position is hybrid, requiring 2 days on-site and 3 days remote work.
- The work schedule is Monday through Friday.
- Full-time employment (40 hours per week) with a comprehensive benefits package.
- To effectively work remotely, employees must have a broadband internet connection with a minimum speed of 24MBS download and 8 MBS upload. Higher speeds will enhance performance.
- Ensure that the address provided in your application is a physical address, as it will be used for sending company equipment.
The salary range for this position is $116,000 per year, with variations based on geographic location, internal equity, and individual qualifications. At Gainwell Technologies, you will have the opportunity to advance your career in a company that values flexibility, learning, and professional development. All full-time salaried employees are eligible for a generous vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also offer various leadership and technical development programs to enhance your skills and capabilities.
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 consideration for employment without regard to race, religion, color, national origin, gender, sexual orientation, gender identity, age, veteran status, disability, or other legally protected characteristics. We celebrate diversity and are committed to creating an inclusive environment for all employees.