Clinical Reviewer, Dental Hygienist

Job not on LinkedIn

🔥 11 minutes ago

🇺🇸 United States – Remote

💵 $58k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Perform first-level clinical reviews of dental claims and pre-treatment estimates using established clinical guidelines, policies, and delegated authority • Approve claims meeting clinical, contractual, and documentation requirements • Evaluate radiographs, dental charting, narratives, treatment records, and claim histories using evidence-based guidelines and clinical expertise • Refer complex cases, potential denials, or adverse benefit determinations to Dental Advisors or designated clinical authorities for final determination • Identify required documentation, provide clear processing instructions, and document review findings accurately in claims systems • Apply ADA CDT coding knowledge, dental terminology, clinical documentation standards, and contractual provisions • Identify and escalate unusual practice patterns, utilization trends, potential fraud, waste, abuse concerns, policy gaps, or workflow issues • Collaborate with Dental Advisors, Claims, Provider Relations, and team leads to support operations and provider communications • Maintain compliance with HIPAA, privacy standards, organizational policies, and regulatory requirements • Work a five-day, eight-hour schedule totaling 40 hours per week, with shifts between 8:00 AM–8:00 PM ET and weekend and holiday rotation coverage

🎯 Requirements

• 5+ years of clinical experience as a dental hygienist in a private practice or comparable dental healthcare setting • Active Registered Dental Hygienist (RDH) license or relevant clinical dental credential in good standing • Strong working knowledge of ADA CDT coding, dental terminology, dental procedures, and clinical documentation • Demonstrated ability to read and interpret dental radiographs, charting, clinical narratives, and treatment records • Excellent analytical, organizational, communication, and problem-solving skills with high attention to detail • Proficiency with claims-processing systems, electronic health/dental records, and standard digital tools • Experience with technology-enabled workflow improvements, particularly with AI/LLM tools • Prior experience in dental insurance claims review, utilization management, or health plan clinical operations, ideally within a Medicare Advantage or managed care setting

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • Parental leave program • 401K program

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