Director of Clinical Audits and Peer Reviews

Overview

We are looking for a Director of Clinical Audits and Peer Reviews to join our compliance team. This individual will report to the Compliance Director and assist the Compliance Department i Develop and execute a comprehensive clinical audit and peer review strategy aligned with organizational quality and compliance goals.

Responsibilities:

 

Audit and Compliance Oversight:

• Conduct internal audits, peer audits, and internal investigations
• Manage and respond to external audits (insurance companies, regulatory agencies, state dental boards, legal entities)
• Oversee external insurance payment audits
• Identify compliance risks and implement corrective action plans
• Present compliance workflows and documentation standards

Management of Peer Audit Program:

• Design and select procedures for peer audit review
• Train and educate auditors on audit protocols and software tools
• Analyze peer audit results and present findings to clinical leadership
• Facilitate follow-up and resolution of issues identified during audits

 Clinical Review and Risk Management:

• Participate in clinical review of patient and internal complaints
• Support investigations involving clinical care and documentation
• Work with Quality Assurance Committee of the Oral Health Board to address issues identified during clinical reviews
• Participate in Credentialing committee workflows and meetings for clinical review of re-credentialling matters
• Serve as expert for state and federal dental practice act regulations, including allowable and prohibited duties by clinical role

Infection Control and Regulatory Compliance:

• Oversee infection control compliance across supported practices
• Monitor Direct Unit Water Line (DUWL) testing and weekly spore testing completion
• Troubleshoot sterilization and testing issues with offices
• Provide guidance on sterilization, disinfection, and PPE standards

Training and Education:

• Provide onboarding education for new hires
• Deliver ongoing training on compliance, infection control, and vendor tools
• Support adoption of organizational protocols and best practices

Other:

• Monitor key performance indicators (KPIs) related to audits and infection control
• Prepare and deliver quarterly reports to executive leadership
• Collaborate with executive and operational leadership, including the Chair of the Oral Health Board, Vice Presidents of Operations and Clinical Operations, and Regional Directors of Operations.
• Advocate for company-wide clinical standards

 

Qualifications:

• At least eight (8) to ten (10) years experience of in a clinical dental environment
• Comprehensive knowledge of dental procedures and CDT coding
• Understanding of insurance billing practices and documentation requirements
• Knowledge of state Dental Practice Acts and scope of practice for dental healthcare personnel (DHCP)
• Ability to analyze audit findings and provide actionable recommendations
• Ability to interpret radiographic images
• Working knowledge of clinical dentistry across specialties
• Understanding of standard of care and risk exposure
• Knowledge of CDC and ADA infection control guidelines
• Knowledge of OSHA Bloodborne Pathogen (BBP) Standard and workplace safety requirements
• Understanding of best practices for sterilization, disinfection, and dental operatory setup
• Knowledge of regulatory compliance requirements and inspection readiness
• Strong presentation and communication skills
• Proficiency in Open Dental (OD) reporting and MS Office, especially PowerPoint, Word and Excel
• Attention to detail; very organized
• Ability to interact with people at all levels of the corporate structure, prioritize and handle numerous competing demands in a high-volume, fast-paced working environment
• Ability to work independently and complete job responsibilities without significant oversight

Why You’ll Love Working Here

• Comprehensive Benefits: Including 401(k).
• Paid Time Off: Competitive PTO that grows with your career.
• Career Growth: Opportunities for continuing education and development.
• Exciting Work Environment: A supportive atmosphere that celebrates individuality and teamwork, allowing you to thrive.

Equal Opportunity EmployerWe embrace diversity and are committed to creating an