Staff Dentist (Insurance Claims Review)

LIBERTY Dental Plan; Tustin (CA); On-site; USD 130,000 - 160,000; Full time

Job summary

Join a leading dental insurance company as a Staff Dentist in Tustin, CA. This role involves clinical review, utilization management, and ensuring quality care across various dental programs. The ideal candidate will have a DDS/DMD degree and relevant experience in claims processing.

Benefits

Competitive pay structure

Excellent 401(k) retirement benefits

Affordable medical insurance

100% employer-paid dental coverage

Vision insurance

Flexible Spending Accounts

Voluntary benefit programs

Long-term disability coverage

Generous vacation and sick leave policies

Tuition reimbursement

Qualifications

• 2 years experience in processing claims preferred.
• 4+ years experience as a practicing dentist.

Responsibilities

• Conduct clinical review of claims and pre-authorizations.
• Participate in Quality Management and Improvement activities.
• Conduct Peer-to-Peer calls to discuss utilization trends.

Skills

Knowledge of clinical dentistry procedure codes

Ability to examine and read dental radiographs

Project management exposure

Education

DDS/DMD Degree

Active, unrestricted license to practice dental

Job description

Job Details

Job Location: LIBERTY Dental Plan Corp. - Tustin, CA

Position Type: Full Time

Salary Range: Undisclosed

Job Shift: Day

Description

Join Liberty Dental Plan as We Shape the Future of Dental Insurance!

Liberty Dental Plan is looking for a New Jersey Licensed Staff Dentist to join our growing team! Unrestricted license or certification to practice dentistry in the State of New Jerseyand the ability to obtain a license in the State of West VirginiaREQUIRED.

The Staff Dentist will primarily be responsible for the Utilization Management and Utilization Review Programs and ensuring the timely oral health decision-making and adjudication of dental claims and prospective requests for dental services (referrals and pre-authorizations) across all lines of business including Commercial, Medicare Advantage and Medicaid programs to help ensure financial stability and quality of care. A staff dentist will be involved in state oral health programs of Liberty, as well as other clinical review activities and duties outlined below.

Job Summary Details

• Conduct clinical review of claims and pre-authorizations for all lines of business and/or markets as needed to ensure LIBERTY meets their contractual regulatory timeframes.

• Participate in all clinical trainings, calibrations and Interrater reliability testing while also meeting all required quality and calibration benchmarks required by LIBERTY and state/federal regulations.

• Participate and/or complete Quality Management and Improvement activities, DCM and SIU activities (provider site reviews/or consultations, utilization management and utilization review analysis, counseling calls, etc.) and recommend actions to resolve identified provider trends and treatment patterns.

• Conduct Peer-to Peer calls to discuss utilization trends, quality issues and trends in prospective and retrospective claims submissions.

• Conduct secondary reviews such as grievance and appeal review.

• Identify potentially unnecessary services in relation to care delivery settings.

• Identify potential quality issues and trends in prospective and retrospective claims submissions.

• Examine dental charts for focused audits of aberrant utilization and care delivery patterns.

• Occasional on-site chart review for the state provider network.

• Attend meetings of supervisory and administrative staff to discuss department operations, clinical findings and staff training needs.

• Use clinical expertise to make appropriate dental interpretations and decisions, as required.

• Develop and maintain subject matter expertise in LIBERTY dental benefit plans and applicable State Medicaid Programs. As requested, contribute to required regulatory reporting.

• Participate in Quality Improvement and Provider Credentialing Committees and provide input on appropriate resolution of member and/or provider grievances.

• Collect and evaluate data from Grievance, Peer Review, Public Policy, and the Credentialing Sub-Committee on a quarterly basis.

• Participate in enrollee Tele-dentistry visits to provide clinical assessment, evaluations, and recommendations based on dental need.

• May consult periodically with Dental Board-eligible and/ or certified specialist or academic specialist within the community to make informed decision for individual enrollees.

• The position description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee.

• Perform other duties as assigned.

Qualifications

Education/Experience

• DDS/DMD DegreeActive, unrestricted license or certification to practice dental or related health profession in a state or territory of the United States of America in good standing (must pass credentialing - no probation or listed sanctions)
• 2 Years experiencein processing claims in accordance with policy, including prior experience training peers preferred.
• 4+ Years experience as a practicing dentist

Specific Skills/Knowledge

• Knowledge of clinical dentistry procedure codes and generally accepted clinical and adjudication guidelines on medical necessity of proposed dental procedures.

• Demonstrated performance in managing oral health care cost and utilization management.

• In-depth knowledge of commercial and managed care delivery systems, reimbursement mechanisms, state regulatory and legislative landscape and quality improvement initiatives.

• Ability to examine and read dental radiographs and chart records.

• Ability to be successfully credentialed and re-credentialed by LIBERTY Dental Plan.

• Must comply with applicable federal and state statutes and regulations.

• Project management exposure with the ability to create and implement plans successfully.

• Computer literacy with the ability to easily acquire working knowledge of new system applications.

• Ability to apply alternate benefits where applicable, and consistent with plan guidelines and/or generally accepted professional protocols or guidelines.

• Ability to work in a team providing leadership and implementing the consensus or organizational required activities.

• Complete all necessary CE credits associated with maintaining your dental licensure.

• Additional state licensures may be needed to meet regulatory needs of the company.

Location

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

What Liberty Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

Our first-class benefits package supports employees and their dependents with:

• Competitive pay structure and savings optionsto help you reach your financial goals.

• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.

• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.

• 100% employer-paid dental coveragefor employees and eligible dependents.

• Vision insurancewith low-cost premiums for employee-only coverage and dependents.

• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.

• Flexible Spending Accountsfor healthcare and dependent care expenses.

• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.

• Long-term disability coverage.

• Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.

• Employee Assistance Program (EAP)to support mental health and well-being.

• Generous vacation and sick leavepolicies, with the ability to roll over unused time.

• 10 paid company holidays.

• Tuition reimbursementfor eligible educational expenses.

• Remote or hybrid work optionsavailable for various positions.

Compensation

In the spirit of pay transparency, the base salary range for this position is $130,00 - $160,000, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.