Dental Hygienist-NDC- Advanced (673100)

Minimum Qualifications

• Possess a current active Pennsylvania Dental Hygienist license in good standing.
• Demonstrate an understanding of utilization review processes.
• Knowledge and use of basic computer programs to include, but not limited to, Microsoft Office Products.

Role Description

• 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 recordkeeping 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 workgroups, as assigned.

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com