Dental Hygienist (1123-01-rv)
Dental Hygienist | Harrisburg, PA | Full Time and Contract
Work Location: Harrisburg, PA
Job Duties/Responsibilities/Functions (including but not limited to)
- Conduct retrospective reviews to determine if dental services were provided, billed and paid in accordance with applicable state and federal regulations through research, analysis and application of regulations, policies and standards of care.
- Evaluate the appropriateness of care, including medical necessity, place of service, quantity, quality and compensability of services ordered and provided to recipients in the Fee-for-Service and Managed Care delivery systems
- Review claims and encounters to identify those providers/recipients whose billing/service patterns indicate fraud/waste/abuse.
- Review medical and fiscal records to determine if records were properly maintained, reflect services rendered and meet required standards of practice
- Participate in on-site visit to the provider’s place of service to observe the treatment setting, interview provider and staff regarding process flow and services provided, evaluate record keeping and billing procedures and/or to obtain medical/fiscal records for review.
- Discuss case findings with dental consultant, supervisor/manager, DHS attorneys and law enforcement agencies, as warranted, to determine administrative action or referral to other state and federal agencies or law enforcement.
- Prepare correspondence, referrals, and reports.
- Respond to inquiries from providers or recipients.
- Prepare case and testify at administrative hearings to defend the Department’s action.
- Attend relevant meetings and participate in work groups, as assigned.
- Performs other duties as assigned.
- Possess a current active Pennsylvania Dental Hygienist license in good standing - Dental Hygienist State License - Required.
- Demonstrate an understanding of utilization review processes.
- Basic Computer Skills – Required - Knowledge and use of basic computer programs to include, but not limited to, Microsoft Office Products.
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.