DentaQuest · 1 month ago
New Mexico Sr. Clinical Dental Consultant, DentaQuest
Albuquerque, NM
Full-time
Hybrid
Senior Level
$131K/yr - $196K/yrDentaQuest is a leading provider of dental and vision benefits, managing care for over 33 million Americans. The Sr. Clinical Dental Consultant will review claims, evaluate appeals, and provide clinical support to ensure quality care and compliance with regulations.
DentalHealth CareHospitalInsuranceMedicalWellness
Responsibilities
Authorize or deny claims based on medical necessity and eligibility, in accordance to contract language after clinical review enters claim status into the system
Evaluate appeals and identify if proper documentation has been obtained to deny claim. Make further recommendations, request additional information, review charts, and make revised or reiterate claim decision
Reviews authorization requests for anesthesia and rendering judgement on medical necessity
Review and render conclusions on all orthodontic claims for handicapping malocclusions specific to each Market contract
Communicate claim review outcome to participating Dentists, plan members, and Health Plans
Facilitate and give Provider orientations
Communicate to management ways to improve processes and productivity of company
Develop a full comprehension of the administration of the dental program, including, but not limited to: benefit and authorization requirements for Plans and/or States, claims payment and the denial process, and a business understanding of ASO and Risk relationships
Develop knowledge and understanding of state and federal dental regulations, and proactively alert staff of changes that are taking place
Provide guidance and education in the provider community on the dental program; provide recommendations in managing the dental program efficiently and effectively
Represent the company in a professional manner for the market, including meetings associated with the provider community
Proactively seek out opportunities to speak on the benefits of Medicaid and Medicare dental programs
Identify community opportunities for the company to participate within, including, but not limited to: health fairs, dental screenings, back to school programs, etc
Develop an understanding of the oral health wellness and outreach programs offered, working closely with Dental Consultants and staff
Review dental cases to represent the company at fair hearings, as needed
Establish relationships with dental associations and key stakeholders in the surrounding region, helping to solidify new business in other states
Adhere to business processes
Recruit qualified providers for the network
Other duties as assigned
Qualification
Required
Graduate of an accredited Dental School (D.D.S. or D.M.D)
An active New Mexico Dental License
Maintain an unrestricted dental license
Knowledge of general dentistry
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 between multiple market benefits
Ability to prioritize and organize multiple tasks
Ability to remain organized with multiple interruptions
Networking and Negotiation skills required
Ability to travel as needed
Required to attend additional training as requested/deemed necessary
Candidates must reside in the state of New Mexico
Preferred
Orthodontic experience a plus
Benefits
Generous vacation and sick time
Market-leading paid family, parental and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Company
DentaQuest
DentaQuest is a healthcare firm that provides medical and surgical treatments and services in dentistry.
Founded in 2001
1001-5000 employees
H1B Sponsorship
DentaQuest has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (1)
2023 (5)
2022 (5)
2021 (7)
2020 (7)
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
SMILE Health
2023-08-08Non Equity Assistance
2021-10-03Acquired
Leadership Team
Brian Watts
CEO
Shane Patrick, MBA
Managing Client Director (Oklahoma CEO)
Recent News
2025-10-28
2025-10-16
Company data provided by crunchbase