Claims Adjudication Dental Lead (Dentist)

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

Gainwell Technologies Claims Adjudication Dental Lead applies clinical expertise and leadership to oversee, review, approve, and/or deny dental claims and treatment authorization requests in accordance with CA Department of Health Care Services (DHCS) Medi-Cal Dental policies.

Your role in our mission

• Develop, deliver and maintain training material to staff members to adjudicate Treatment Authorization Requests (TARs), Notices of Authorization (NOAs), Claim Inquiry Forms (CIFs) and claims utilizing standards and procedures set forth by the CA Department of Health Care Services (DHCS) to ensure adherence to Medi-Cal Dental policies and procedures.

 

• Oversee claims adjudication staff, including monitoring and assigning daily work inventory to dental consultants and paraprofessionals to meet Medi-Cal Dental requirements. 

 

• Resolve issues within the Claims Adjudication team and serve as an escalation point, as needed

 

• Develop, update and maintain manuals, standard operating procedures and job aids.

 

• Assists 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) Providing findings to the claims processing team and/or adjudication of claims.

What we're looking for

• A minimum of ten (10) years of prior hands-on, clinical experience as dentist delivering dental services. The candidate must meet all requirements and training set forth by the Board of Dental Examiners in California.

• 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.
• Prior adjudication and claims processing for Medi-Cal Dental in California is a plus, but not a requirement.
• A minimum of three (3) years of experience as a team leader or supervisor
• Expertise and knowledge of Medi-Cal Dental criteria and program requirements.
• Position is Hybrid, with On-Site work (Roseville, CA)

What you should expect in this role

• Full-time work schedule (40 hours per week)
• Benefits start on first day of employment.
  • Health, Dental, Eye are optional (specific rates only discussed in new hire orientation)
  • Flexible PTO policy
  • Continuous training to promote career progression.

• In order to effectively work as a remote worker (work from home) with Gainwell, 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.  
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.

 

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The pay range for this position is $190,100.00 - $271,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible