Dental Consultant Reviewer (PRN - District of Columbia)
About Company: Why Comagine Health? Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years. We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs. Comagine Health actively cultivates an organizational culture that fosters well-being and prioritizes engagement, connectedness and collaboration among team members. Each employee’s unique background, perspective and abilities are fundamental to the success of our mission and organization. Comagine Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. We are proud to be a Recovery Friendly Workplace, supporting the health and well-being of all employees. About the Role: This is a PRN (on-call) position with a typical workload of 6 hours per week. The Dental Consultant Reviewer plays a critical role in ensuring the quality and accuracy of dental care services within the healthcare system. This position involves the thorough review and evaluation of dental claims, treatment plans, and clinical documentation to verify compliance with established guidelines and standards. The role requires collaboration with dental professionals and healthcare providers to provide expert recommendations and support decision-making processes. By identifying discrepancies, potential fraud, or unnecessary procedures, the Dental Consultant Reviewer helps optimize patient care and resource utilization. Ultimately, this position contributes to maintaining high standards of dental care and supports the integrity of healthcare services in the Washington DC area. Minimum Qualifications: Current, active, unrestricted clinical licensure D.C. Washington Dental Hygienist (RDH) • AA/AS in a related field • Graduation from an accredited school of Dental Hygiene • District of Columbia Registered Dental Hygienist • Strong knowledge of dental coding systems (e.g., CDT codes) and insurance claim processes. • Familiarity with healthcare compliance standards and regulatory requirements related to dental services. • Excellent analytical and communication skills to assess clinical information and interact with providers. Preferred Qualifications: • Experience in dental consulting, claims review, or utilization management within a healthcare or insurance setting. • Certification in dental coding or healthcare compliance. • Advanced training or specialization in dental public health, oral surgery, or orthodontics. • Proficiency with electronic health records (EHR) and dental practice management software. • Prior experience working in a multidisciplinary healthcare environment. Responsibilities: • Review and analyze dental claims and clinical documentation for accuracy, completeness, and compliance with regulatory and organizational standards. • Evaluate treatment plans and procedures to ensure they are medically necessary and align with best practices in dental care. • Collaborate with dental providers and healthcare teams to clarify information, resolve discrepancies, and provide expert guidance. • Prepare detailed reports and recommendations based on case reviews to support claims adjudication and quality assurance processes. • Stay current with dental industry regulations, coding standards, and clinical advancements to inform review practices. Skills: The Dental Consultant Reviewer utilizes clinical expertise and analytical skills daily to assess the validity and necessity of dental treatments and claims. Strong communication skills are essential for effectively collaborating with dental providers and healthcare teams to resolve clinical questions and discrepancies. Attention to detail and critical thinking enable the reviewer to identify potential errors, fraud, or inefficiencies in documentation and billing. Familiarity with dental coding and regulatory standards ensures accurate interpretation and application of guidelines during reviews. Additionally, proficiency with digital tools and software supports efficient management of case files and reporting. Apply tot his job