
1001 - 5000 employees
Founded 2002
âď¸ Healthcare Insurance
đ¤ B2B
Healthcare Insurance ⢠B2B
Liberty Dental Plan is a U. S. -based dental insurance provider offering Medicaid (including Medi-Cal), Medicare Advantage, commercial, individual & family, and group dental plans across multiple states. The company operates member-facing services (find-a-dentist, member portal, mobile app, claims and eligibility tools) and provider-facing services (provider portal, network enrollment, claims submission, clinical guidelines, and value-based programs). Liberty Dental Plan focuses on dental benefits administration, provider network management, compliance and credentialing, and serving members, providers, and brokers.
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1001 - 5000 employees
Founded 2002
âď¸ Healthcare Insurance
đ¤ B2B
Healthcare Insurance ⢠B2B
Liberty Dental Plan is a U. S. -based dental insurance provider offering Medicaid (including Medi-Cal), Medicare Advantage, commercial, individual & family, and group dental plans across multiple states. The company operates member-facing services (find-a-dentist, member portal, mobile app, claims and eligibility tools) and provider-facing services (provider portal, network enrollment, claims submission, clinical guidelines, and value-based programs). Liberty Dental Plan focuses on dental benefits administration, provider network management, compliance and credentialing, and serving members, providers, and brokers.
⢠Perform timely clinical adjudication of dental claims and prior authorization requests ⢠Determine medical necessity and benefit coverage using clinical expertise and plan guidelines ⢠Interpret radiographs, charts, and supporting documentation to inform decisions ⢠Identify inappropriate, unnecessary, or low-value services ⢠Participate in quality improvement initiatives, audits, and utilization analyses ⢠Conduct focused chart reviews to identify utilization trends and potential quality concerns ⢠Support SIU activities, including provider site reviews and corrective recommendations ⢠Analyze treatment patterns and recommend improvements ⢠Conduct peer-to-peer consultations with network providers ⢠Participate in grievance, appeal, and secondary review processes ⢠Collaborate with specialists or subject-matter experts as needed ⢠Participate in calibration sessions, trainings, and interrater reliability activities ⢠Attend clinical and operational meetings ⢠Contribute to credentialing and quality committees ⢠Provide clinical input during tele-dentistry consultations when needed ⢠Maintain expertise in dental benefit plans and Medicaid program requirements ⢠Support regulatory reporting and compliance initiatives
⢠DDS or DMD from an accredited dental school ⢠Active, unrestricted dental license in good standing in a U.S. state ⢠Minimum: 4+ years practicing as a dentist ⢠2+ years experience with claims review, utilization management, or payer-side dentistry preferred ⢠Strong knowledge of: Dental coding and clinical guidelines ⢠Managed care and reimbursement systems ⢠Medical necessity criteria and adjudication processes ⢠Ability to interpret radiographs and dental records ⢠Strong analytical, decision-making, and communication skills ⢠Current professional malpractice insurance required (must be maintained throughout the contract period)
⢠Fully remote opportunity with flexible scheduling ⢠Opportunity for contract extension based on performance and business needs
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