Dental Consultant (Part-Time)

POSITION SUMMARY

Responsible for the accurate and timely processing of commercial, Medicare, and Medicaid dental claims pended for dental consultants' review. Assist the Dental Director in ensuring dental offices are in compliance with all HDS agreements, by-laws, clinical standards, and established policies and procedures. Provide clinical advice to HDS personnel.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Objectively review submitted treatment plans in accordance with established HDS policies, procedures, or specific instructions to determine if the service is within accepted clinical standards of care and the scope of benefits based on employer group contracts. Apply appropriate procedure codes and/or fees for service rendered during the claims review process as needed. 
• Inform participating dentists about HDS clinical processing policies, appropriate claims submission requirements, and HDS’ philosophy as to dental benefits in Hawaii. Address oral and written inquiries and complaints from dentists, dental staff, subscribers, and members in an accurate, proper, professional, and timely manner.  
• Detect and refer to the Dental Director any noted aberrant dentist clinical practices/trends. As directed by the Dental Director, communicate with dentists and dental staff personnel unusual practice patterns and provide appropriate counseling and advice to correct/improve their practice patterns.
• Provide quick and accurate response to inquiries/questions from HDS personnel.
• Develop and implement new HDS clinical processing policies when identified and needed. Review, update or modify existing HDS clinical processing policies, as needed.
• Attend weekly Dental Consultant meetings and periodic calibration exercises as the individual work schedule allows.
• Other Duties & Responsibilities

1. Provide clinical and technical expertise on existing HDS programs designed to monitor provider compliance.
2. Implement, coordinate, and resolve the HDS peer review complaint process, when required.
3. Assist the Dental Director in recommending and establishing potential new benefits in HDS benefit plans.  
4. Provide training, as necessary, to HDS staff, brokers, employer groups, subscribers, and members.  
5. Review claims processing policies and procedures for possible cost containment (reviewing, cross checks, processing policies, attachment requirements, etc.). 
6. Maintain current information on evidence based dental practice, equipment, medications, dental materials, treatment and techniques that may affect HDS.

MINIMUM QUALIFICATIONS AND EXPERIENCE

Education

DMD/DDS or equivalent degree from a Commission on Dental Accreditation (CODA) accredited university.  

Experience

• Ability to organize, analyze and problem-solve complex administrative and clinical problems.
• Ability to handle multiple tasks and prioritize appropriately.
• Ability to communicate both orally and in writing with all levels of staff, customers, consultants/brokers, and vendors on sensitive matters.
• Technical knowledge to understand computer applications for problem-solving and answering staff questions (prefer Windows, Word, Excel, and PowerPoint).

Licenses/Certification

Must posses a current, active State of Hawaii dentist license.

Skills and Knowledge

• Ability to handle confidential and sensitive issues and materials.
• Ability to organize, analyze and problem-solve somewhat complex problems.
• Ability to handle multiple tasks, and prioritize with distractions and with attention to details.
• Ability to communicate both orally and in writing with all levels of staff, customers, consultants/brokers, and vendors on sensitive matters.
• Technical knowledge to understand computer applications for problem-solving and answering staff questions (prefer Windows, Word, Excel, and PowerPoint).

Note: The above information on this description has been designed to indicate the general nature and level of work performed by an employee in this classification.  It is not to be interpreted as a comprehensive inventory of all duties, responsibilities, and qualification of employees assigned to this job.  Hawaii Dental Service has the right to add to, revise, or delete information in this description.  Reasonable accommodations will be made to enable qualified individuals with disabilities to perform the essential functions of this position.