Overview

CoventBridge Group is seeking a Dental Review Specialist for a specific project on a contract basis, providing expertise and support in reviewing Medicare and Medicaid claims. This position is essential for delivering dental services insight to aid in decision-making processes and ensuring our clients receive the highest level of service and care. As a Dental Review Specialist, you will be instrumental in identifying and eliminating fraud, waste, and abuse to improve healthcare delivery.

Must be licensed in the state of Michigan.

This position will report directly to the Medical Director and can work remotely.

Responsibilities/ Requirements

Essential Duties & Responsibilities:

• Performs claims coverage reviews or review oversight for dental services using insight and expertise to apply national / local / state specific rules for coverage and payment issues.
• Interact with Medical Director to share information and coordinates contractor policy development when appropriate.
• Interact as necessary with professional dental groups, state or national dental organizations, State Medicaid agencies and/or congressional offices.
• Maintain working knowledge of dental practice standards, guidelines, and related technology.
• Contributes to the development of contractor policy, including necessary updating of policies and the development of written guidelines used by the UPIC.
• Present dental specialty education sessions as needed.
• Provide expert testimony as required.
• Complies with PIM guidelines and CMS directives concerning Dental Reviews and supports hearings and appeals.
• Approximately 200 hours of work over the course of 2 months.

Competencies:

• Interpersonal, problem solving and communication (both written and verbal) skills.
• Computer literacy
• Working knowledge of the Medicare and Medicaid programs, particularly the coverage and payment rules.
• Ability to manage time and workload to ensure deadlines are met.

Basic Qualifications:

• 3 or more years as a Board certified Doctor of Dental Surgery or Doctor of Dental Medicine
• 3 or more years practicing dentistry as a board-certified Doctor of Dental Surgery or Doctor of Dental Medicine.
• Must have an active valid and unrestricted license.
• Prior work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization.
• Must have no adverse actions pending or taken against by any State or Federal licensing board or program.

Preferred Qualifications

• Public relations experience such as collaborating with professional dental groups, state or national dental organizations, State Medicaid agencies and/or congressional offices is preferred.
• Familiarity with the State of Iowa

Benefits

The hourly range for this role is $150 / HR. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

About Us:

CoventBridge Group is the global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients' needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.

CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.

CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.

UPIC