Clinical Consultant

Market leading insurance company looking for hybrid Dental Consultants in MA! This is work from home opportunity with local travel in MA (mileage reimbursed)! Must be a licensed DDS or DMD in MA for this role!

As a Dental Consultant, you'll serve as a clinical subject matter expert for the organization, preparing for and attending MassHealth Board of Hearing (BOH) events throughout Massachusetts. This flexible, as-needed role typically requires 3-4 working days per month, with up to 10 hearings per day.

PRIMARY JOB RESPONSIBILITIES:

• Attend in-person or telephonic Board of Hearing (BOH) events at various Massachusetts locations.
• Prepare expert testimony from hearing packets provided for each BOH event and defend the clinical rationale of adverse benefit determinations. This includes clearly explaining the clinical criteria applied to prior-authorizations or claims denied.
• Evaluate appeals and determine if proper documentation has been obtained to appropriately deny the prior-authorization or claim.
• Represent professionally at all times.
• Develop knowledge and understanding of state and federal dental regulations.
• Adhere to business processes.

JOB REQUIREMENTS:

• Graduate of an accredited Dental School (D.D.S. or D.M.D).
• 5 years of clinical experience preferred.
• Maintain an unrestricted Massachusetts dental license.
• Ability to travel to the location where these BOH events are held.
• Knowledge of general dentistry.
• Orthodontic experience a plus.
• Efficient PC skills.
• Ability to use analytical/presentation tools such as Excel and PowerPoint.
• Organizational and time management skills.
• Ability to work with a team and independently to complete assigned tasks without supervision.
• Ability to make independent determinations on all types of dental claims.
• Excellent written and verbal communication skills. Ability to distinguish market benefits on qualifying clinical criteria.
• Ability to prioritize and organize multiple tasks.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.