Part Time National Dental Specialist, PA

Avēsis; Whitpain Township (PA); On-site; USD 60,000 - 100,000; Part time

Job summary

An established industry player is seeking a Part-Time National Dental Specialist to review dental claims and ensure compliance with regulations. This role involves engaging with providers, managing pre-authorizations, and conducting audits to uphold quality standards. With a focus on effective communication and project management, the position offers a flexible work environment and competitive compensation. Ideal candidates will have extensive orthodontic experience and a commitment to excellence in dental care. Join a team that values diversity and inclusion while making a significant impact in the dental field.

Benefits

Comprehensive Benefits

Flexible Work Environment

Commitment to Diversity and Inclusion

Qualifications

• 7+ years of orthodontic practice experience.
• Credentialing per NCQA guidelines required.

Responsibilities

• Review Medicaid and commercial dental claims and preauthorizations.
• Support network relationships and ensure compliance with FWA controls.

Skills

Effective Communication

Project Management

Microsoft Office

Knowledge in Dental Care Delivery

Familiarity with CDT Codes

Education

Dental Degree (DDS or DMD)

Active Pennsylvania Dental License

Board Certification in Orthodontics

Job description

Join us to apply for the Part Time National Dental Specialist, PA role at Avēsis.

This position involves reviewing Medicaid, CHIP, Medicare Advantage, and commercial dental claims and preauthorizations, supporting network relationships, and ensuring compliance with fraud, waste, and abuse (FWA) controls. The role requires licensure and residence in Pennsylvania.

The job responsibilities include:

1. Claim Review and Utilization Management
2. Pre-Authorization Review: processing claims, reviewing documentation, and ensuring medical necessity within plan guidelines.
3. Post-Service Reviews: assessing services for compliance.
4. Appeals: reviewing and attending provider appeals committees.
5. Audits/FWA: reviewing audit cases related to compliance.
6. Peer-to-Peer Reviews: discussing denials with dental offices.

Additional duties involve supporting state fair hearings, assisting with utilization management and FWA reviews, and providing clinical and administrative support across various committees and initiatives.

Qualifications include:

• Dental Degree (DDS or DMD) from an accredited U.S. Dental School.
• Active, unrestricted Pennsylvania Dental License; multi-state licensure preferred.
• Board certification in orthodontics from the American Board of Orthodontics.
• At least 7 years of orthodontic practice experience.

Skills required include effective communication, project management, and familiarity with Microsoft Office. Knowledge in dental care delivery, plan designs, CDT codes, and membership in dental associations is a plus.

Other requirements include credentialing per NCQA guidelines and willingness to travel as needed.

We offer competitive compensation, comprehensive benefits, a flexible work environment, and a commitment to diversity and inclusion.