Clinical Reviewer, Dental Hygienist
Core
Licensed dental hygienist performing first-level clinical reviews of dental claims and pre-treatment estimates using established guidelines to ensure accurate, timely, and compliant utilization management.
Role type
Senior IC clinical reviewer (dental)
Builds
Approved dental claims and pre-treatment estimates for Devoted Health members
Domain
Dental insurance / Utilization management
Required skills
Dental claims review, Utilization management, ADA CDT coding, Radiograph interpretation, Clinical documentation standards, Claims systems proficiency, HIPAA compliance, Analytical skills, Problem-solving, Attention to detail
Preferred skills
Dental insurance claims review experience, Medicare Advantage experience, Managed care experience, AI/LLM tools experience
Technologies
Claims-processing systems, Electronic health/dental records, AI/LLM tools
Responsibilities
Review assigned dental claims and pre-treatment estimates for clinical, contractual, and documentation compliance; Evaluate radiographs, dental charting, narratives, and treatment records using evidence-based guidelines; Refer complex cases or potential denials to Dental Advisors for final determination; Identify required documentation and document review findings in claims systems; Apply ADA CDT coding and contractual provisions; Identify and escalate unusual practice patterns, fraud, waste, or abuse concerns; Collaborate with Dental Advisors, Claims, and Provider Relations teams.
Seniority
Mid-level, hands-on IC