Dental Consultant (Claims Adjudication Dentist) - Roseville, CA

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 Dental Consultants (Dentists) apply clinical expertise to review, approve, and/or deny dental treatment authorization requests and claims in accordance with CA Department of Health Care Services (DHCS) Medi-Cal Dental policies. Applications for this position will be accepted through December 1, 2024.

Your role in our mission

• Review dental records to determine medical necessity of oral health services within professionally recognized standards of care.
• Manually adjudicate Treatment Authorization Requests (TARs), Notices of Authorization (NOAs) 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.
• Works within a team of dental consultants, sharing a proportional workload of prior authorization and/or claims processing that have been determined to need professional expertise. These claims have been referred from other members of the Claims Processing team, usually involving special needs patients, and good communication skills are necessary for continuity within the business operations.
• When needed, dental consultants assist with training and orientation of new dental consultants, providing guidance and mentoring, such as job coaching and peer interaction including assistance with complex cases or claims.
• 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.
• Work and live within the state of California.

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 California, which is in good-standing and free of any suspensions or sanctions from Federal, State, or local jurisdictions. This will be verified during a post-offer background check.
• Prior adjudication and claims processing for Medi-Cal Dental in California is a plus, but not a requirement.
• Expertise and knowledge of Medi-Cal Dental criteria and program requirements.
• Position will be temporarily remote within California until nearly the end of 2025 and switched to a hybrid schedule, which is On-Site in Roseville, CA as needed, and working from home on other days. 

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
  • Monday through Friday work schedule (8 hours per day totaling 40 hours per week).
  • Our hybrid schedule is working from home on two or three days per week and in the Roseville, CA office on other days.
• Upward career advancement is possible and encouraged.
• Health (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• Company computer provided for work purposes.
• For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload