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Dental Hygienist
Oklahoma City, OK
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+ 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 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, multi-agency special projects as required. + Creates and maintains spreadsheets pertaining to Dental Unit. Identify system issues and collaborate with appropriate staff when necessary. + Represent 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.
Minimum Qualifications
+ • 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.)
Benefits
+ Competitive Pay + Health, Dental, Vision, Life & Short-Term Disability Insurance(eligibility begins after 60 days) + 401(k) Retirement Plan + Travel Stipends for Qualified Candidates
Ready to Get Started?
Apply through this job posting and submit your most recent resume. For questions about this opportunity, please contact
Michelle
at •(800) 928-5561•, Monday through Friday, 8:30 AM-5:00 PM PST.
Health Advocates Network, Inc. is an equal opportunity employer. All qualified applicants shall receive consideration for employment without regard to any legally protected basis under applicable federal, state or local law, except where a bona fide occupational qualification applies. EOE including Veterans/Disability