Dental Consultant- California

About the role

Gainwell Technologies Dental Consultants apply their clinical expertise to review, approve, and/or deny dental treatment authorization requests and claims in accordance with California Department of Health Care Services (DHCS) Medi-Cal Dental policies. Your role in our mission includes supporting adjudication decisions, collaborating within a team, assisting with training and onboarding, and providing support to other departments.

Responsibilities

• Review, approve, and/or deny claims, TARs, and related documentation for California Medi-Cal members to ensure compliance with Medi-Cal Dental policies and procedures.
• Collaborate with a team of dental consultants to manage a shared workload of claims requiring professional expertise.
• Communicate and collaborate effectively to maintain operational continuity, especially when managing complex cases involving special-needs populations.
• Provide support to fellow dental consultants by reviewing complex cases and offering second opinions.
• Assist with the training and onboarding of new dental consultants through guidance, mentorship, job shadowing opportunities, and coaching.
• Support other departments as requested, including Claims Processing and Operations, Provider and Member Services, Grievances and Appeals, Human Resources, Onboarding, and Interviews, Quality Management, Peer Review, and referrals to and reviews of findings and adjudication related to Clinical Screening Dentist evaluations.

Requirements

• A minimum of ten (10) years of hands-on clinical experience practicing dentistry in a general dentistry setting or a recognized dental specialty.
• An active (non-expired) license to practice dentistry in California, in good standing and free of any suspensions, restrictions, or sanctions.
• A minimum of two (2) years of experience working within an organization that provides Medi-Cal Dental services.
• Prior experience with adjudication and claims processing for the California Medi-Cal Dental Program is preferred but not required.
• Demonstrated expertise and in-depth knowledge of Medi-Cal Dental criteria, policies, and program requirements.

Qualifications

• California residency required.
• Full-time, exempt salaried position (40 hours per week).
• Remote position with occasional onsite presence required at our Roseville, CA office, based on business needs.
• Employee must maintain Gainwell Technologies as their sole full-time employer.

Benefits

• The pay range for this position is $121,700.00 - $173,800.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.
• All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance.
• We offer a variety of leadership and technical development academies to help build your skills and capabilities.

Pay

The pay range for this position is $121,700.00 - $173,800.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Schedule

Full-time, exempt salaried position (40 hours per week).

Benefits

• Comprehensive health benefits.
• Educational assistance.
• Flexible vacation policy.
• 401(k) employer match.