Medical Expert – Dental Provider Engagement Specialist

🔥 9 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $90.9k - $129.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Serve as an advanced resource for Medicaid dental providers on prior authorizations, documentation, covered services, and ForwardHealth policy • Provide escalated technical assistance, provider education, and outreach • Partner with internal teams to ensure consistent provider communications and address recurring concerns • Represent the dental program at meetings, trainings, conferences, and stakeholder events • Guide providers on prior authorization requirements, documentation standards, and coverage criteria • Review and adjudicate dental prior authorizations within delegated authority and established policies • Support adjudicators with coverage assistance, inventory management, data corrections, workflow coordination, and process improvements • Maintain proficiency with systems and tools supporting prior authorization operations • Manage administrative workflows for dental prior authorization appeals, including preparation, submission, correspondence, documentation, and deadline compliance • Coordinate clinical and policy input and identify appeal trends • Support implementation of dental policies, benefits, prior authorization requirements, and documentation standards • Collaborate on workflow development, provider education materials, communications, and process improvements • Track and analyze provider inquiries, outreach activities, authorization and appeal trends, and participation barriers • Provide recommendations and reports to leadership • Represent the dental team in operational meetings and maintain knowledge of applicable policies and best practices

🎯 Requirements

• Current, unrestricted Wisconsin license as a Registered Dental Hygienist (RDH), or other dental professional credential appropriate to the assigned scope of work • Substantial clinical dental experience • Experience providing care to Medicaid-enrolled or other publicly insured populations strongly preferred • Experience with Medicaid, dental benefits administration, prior authorization, dental insurance, provider relations, or public-sector health programs preferred • Ability to interpret clinical and administrative policy and translate complex requirements into clear, practical guidance • Knowledge of dental prior authorization, clinical documentation, billing, and claims concepts • Strong interpersonal, written, verbal, training, and presentation skills • Ability to manage multiple priorities, exercise sound judgment, identify when issues require escalation, and collaborate across teams • Ability to analyze provider questions, prior authorization activity, and appeals and recommend improvements • Proficiency with Microsoft Office applications and virtual meeting platforms • Ability to learn and use Medicaid claims, document-management, and prior authorization systems

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Flexible work flexibility • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Career growth opportunities