Dental Auditor

Key Responsibilities

• Perform clinical audits of dental records, and utilization to assess compliance with policies, CADP standards, state/federal regulations, and payer requirements.
• Evaluate medical necessity, coding accuracy (CDT), documentation quality, and adherence to evidence-based guidelines.
• Support readiness for external reviews and accreditation surveys; maintain audit tools, checklists, and SOPs.
• Provide provider education and feedback to improve documentation, coding, and clinical quality.
• Maintain strict confidentiality and data security in accordance with HIPAA and company policies.

Required Qualifications

• Licensed Dentist in California with an active status
• CADP-certified auditor (preferred)
• If not currently certified, must obtain certification promptly upon hire
• Strong knowledge of dental benefit design, CDT coding, utilization management, and quality improvement principles
• Excellent analytical, documentation, and report-writing skills
• Strong communication skills with the ability to deliver clear feedback to providers and cross-functional partners

Preferred Qualifications

• Minimum 2 years of experience working with dental plans (payer, DSO, or managed care setting)
• Experience with CADP standards
• Familiarity with fraud/waste/abuse detection, root cause analysis, and corrective action planning
• Experience training or educating providers on documentation and coding best practices

Work Schedule and Environment

• Full-time, Monday–Friday
• Primarily office-based, with potential travel for provider site audits within California

Performance Metrics

• Accuracy and completeness of audit findings and reports
• Timeliness of audits and follow-up validations
• Reduction in error rates and repeat findings
• Provider satisfaction with education and feedback
• Compliance with CADP and regulatory standards