LI
Dental Hygienist
LanceSoft Inc
🌏 Worldwide
Remote
Manager or above
4 weeks ago
$39.29 – $51.43 / hour
- prior authorization
- dental hygiene
4 weeks ago
Not enough detail in this posting to match
Under supervision, responsible for researching, reviewing, and analyzing dental provider prior authorization requests per federal mandates to ensure compliance with SoonerCare policy, procedures, and billing practices to identify potential over or under utilization and/or fraud. Principal Activities May Include: • Determines compensability for dental services requested for SoonerCare-eligible members by interpreting doctors' statements, dental and medical records, and agency forms to ensure eligibility standards are met. • Works with agency Dental Director and consultants in evaluating members’ medical conditions to determine medical appropriateness of services requested according to state and federal guidelines. • Reviews and make approval decisions on Periodontal prior authorization requests for dental services based on medical necessity; pend to dentist consultant when not meeting qualifications for approval. • Adheres to all OHCA rules and policies while providing services. • Consults with agency’s Dental Director and consultants as necessary on issues in which technical or clinical assistance is required. • Performs Dental, OHCA and multi-agency special projects as required. • Creates and maintains spreadsheets pertaining to Dental Unit. Identify system issues and collaborate with appropriate OHCA staff when necessary. • Represent OHCA and assist the Dental Director and the Dental Manager with the Dental Focus Group meetings or any other external meetings the Dental Unit may host. This includes sharing duties for preparing and archiving meeting minutes. • Maintain current valid Dental Hygienist license in Oklahoma. • Other duties as assigned. This position does not supervise.
Requirements
Education and/or Experience: • Current valid Dental Hygienist license in Oklahoma • Dental Hygiene certificate/degree from an accredited dental hygiene college. • Five years of clinical experience as a dental hygienist. Preference may be given to candidates with: • Medicaid experience. • Medical review experience. • Bachelor’s degree in Dental Hygiene. • Advanced degree (MPH, MPA, MPM, M.Ed.)
Duration
6-12 months
Dental Hygienist · LanceSoft Inc