Dental Consultant, MassHealth BOH
Location: Boston, Massachusetts US
Job Number: 820
JOB SUMMARY:The Dental Consultant, MassHealth Board of Hearings is the assigned representative of decisions for coverage made by DentaQuest as the third-party administrator on behalf of the MassHealth Dental Program at the Massachusetts Board of Hearings.
PRIMARY JOB RESPONSIBILITIES:
- Work with the DentaQuest MassHealth team to schedule hearings for members who have appealed to the Massachusetts Board of Hearings.
- Prepare a thorough review of each appealed case, including discussion with DentaQuest's Dental Consultants.
- Represent DentaQuest [and MassHealth] with respect to the decision at each hearing.
- Work collaboratively with the MassHealth / DentaQuest consultant team supporting the Massachusetts Board of Hearings to ensure consistency in the application of the rules and regulations established by MassHealth for the plan regarding the decisions made for coverage.
- Document hearing interactions and decisions and communicate the same to the MassHealth DentaQuest team for tracking and appropriate action.
- Attend quarterly meetings with the MassHealth team at DentaQuest and complete online training as needed.
- Other duties as assigned JOB
- Dental Provider / Specialist who is board certified or board eligible and graduated from a Commission on Dental Accreditation approved program.
- 10 years' experience in practice as a licensed dental provider in Massachusetts.
- Ability to provide transportation to and attend hearings at any location deemed necessary per the schedule from the Massachusetts Board of Hearings.
- Excellent oral and written communication skills. Efficient PC skills (Word, Excel, PowerPoint).
- Ability to work as a team member.
- Required to attend additional training as requested/deemed necessary.
- Incumbent must be able to communicate effectively.
- Requires overall light physical effort (up to 25lbs.)
- Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
- Ability to travel or move about within and outside serviced facilities required.
- Incumbent works primarily in either a private or shared office environment.
At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system - from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.
Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and deliveringmeasurableoutcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.
Job Number: 2663
Community / Marketing Title: Dental Consultant, MassHealth BOH
Location_formattedLocationLong: Boston, Massachusetts US