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The Health Plan of West Virginia, Inc.

Dentist - Clinical Reviewer

The Dental Clinical Reviewer is responsible for reviewing dental and oral surgery requests and clinical notes to determine if the claims are eligible for payment based on reasonableness of treatment as it relates to The Health Plan's contract provisions, dental plan benefits and claims administration policies, and dental standards of practice.

  • Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DDM) with a least five years of dentistry experience.
  • Board certification as a Dentist.
  • Active and unrestricted Dentist license.
  • Meets all THP credentialing requirements.

At least three years of managed care experience (with an understanding of appropriate utilization of services and the policies that support these services) preferred.
Desired, but not required:

  • Basic computer literacy.
  • Medical review experience preferred.
  • Pediatric or general Dentist with Medicaid experience.
  • Demonstrated ability to work in unison with other professionals and non-professionals in a respectful and harmonious manner.

Job Type: Part-time

COVID-19 considerations:
Currently, The Health Plan is conducting phone or Skype interviews.

Experience:

  • Microsoft Office: 1 year (Preferred)
  • Medicaid: 1 year (Preferred)
  • Medical Review: 1 year (Preferred)
  • Managed Care: 3 years (Required)
  • Pediatric or General Dentist: 1 year (Preferred)

Location:

  • Wheeling, WV (Preferred)

License:

  • Board Certified Dentist (Preferred)
  • Active & Unrestricted DDS or DDM (Required)

Work authorization:

  • United States (Required)

Work Location:

  • One location

Schedule:

  • Monday to Friday

Company's website:

  • www.healthplan.org

Work Remotely:

  • Yes

Please mention that you come from RemoteJobs when applying for this job.

Posted 2 days ago

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