Dental Consultant - Roseville, CA (Hybrid Schedule)

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 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.

Your role in our mission

• Manually review of claims, Treatment Authorization Requests (TARs) and related documents for California Medi-Cal members for adjudication, ensuring adherence to Medi-Cal Dental policies and procedures.
• Work within a team of dental consultants, sharing a proportional workload of claims processing and adjudication that have been determined to need professional expertise of an experienced dentist. These claims have been referred from other members of the Claims Processing team, 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 shadowing and coaching.
• Assist fellow dental consultants with complex cases or claims needing a second opinion, including collaboration for cases involving Medi-Cal Dental Program special needs populations.
• Assist 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) referral to/review of findings/adjudication of claims related to Clinical Screening dentist evaluations.

What we're looking for

• A minimum of ten (10) years of prior hands-on, clinical experience as a dentist delivering dental services within a general or recognized dental specialty practice.
• 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.
• Minimum of two (2) years working within an organization that provides Medi-Cal Dental services to patients. Prior adjudication and claims processing for the Medi-Cal Dental Program in California is a plus, but not a requirement.
• Demonstrated expertise and knowledge of Medi-Cal Dental criteria and program requirements.
• Position will be required to be On-site (Roseville, CA), with possible Hybrid/Remote schedules, to be determined after hire. 
• Willingness to travel if needed

What you should expect in this role

• Hybrid work environment with 1-2 days a week in the office and as needed with the remainder of time remote work.  The office is located in Roseville (Sacramento, California area)
•  Full-time (40 hours per week) salaried employee benefit package

• In order to effectively work as a teleworker 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.  

 

 

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The pay range for this position is $116,100.00 -