Dental Hygiene Authorization Analyst

Title: Dental Hygiene Authorization Analyst - (Temporary)

Duration: 6-12 months

Location & Schedule: This is a remote position requiring approximately 8 hours per week. - Ok City, Ok.

Interview: In person interview required

Description

Under supervision, responsible for researching, reviewing, and analyzing dental provider prior authorization requests per federal mandates to ensure compliance with SoonerCare policy, procedures, and billing practices to identify potential over or under utilization and/or fraud.

Principal Activities May Include:

Determines compensability for dental services requested for SoonerCare-eligible members by interpreting doctors' statements, dental and medical records, and agency forms to ensure eligibility standards are met.

Works with agency Dental Director and consultants in evaluating members' medical conditions to determine medical appropriateness of services requested according to state and federal guidelines.

Reviews and make approval decisions on Periodontal prior authorization requests for dental services based on medical necessity; pend to dentist consultant when not meeting qualifications for approval.

Adheres to all OHCA rules and policies while providing services.

Consults with agency's Dental Director and consultants as necessary on issues in which technical or clinical assistance is required.

Performs Dental, OHCA and multi-agency special projects as required.

Creates and maintains spreadsheets pertaining to Dental Unit. Identify system issues and collaborate with appropriate OHCA staff when necessary.

Represent OHCA and assist the Dental Director and the Dental Manager with the Dental Focus Group meetings or any other external meetings the Dental Unit may host. This includes sharing duties for preparing and archiving meeting minutes.

Maintain current valid Dental Hygienist license in Oklahoma.

Other duties as assigned.

Supervisory Responsibilities: This position does not supervise.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Requirements

Education and/or Experience:

Current valid Dental Hygienist license in Oklahoma

Dental Hygiene certificate/degree from an accredited dental hygiene college.

Five years of clinical experience as a dental hygienist.

Preference may be given to candidates with:

Medicaid experience.

Medical review experience.

Bachelor's degree in Dental Hygiene.

Advanced degree (MPH, MPA, MPM, M.Ed.)

Knowledge, Skills, Abilities and Competencies

This position requires knowledge of dental hygiene principles, practices, terminology, procedures, and standards of care, including periodontal conditions and treatment. Knowledge of dental and medical records, clinical documentation, and criteria used to evaluate dental services is essential. The role requires skill in reviewing and analyzing clinical information, interpreting and consistently applying policies, procedures, and established criteria, and making accurate authorization decisions within assigned authority. Strong analytical, organizational, and attention-to-detail skills are necessary to manage a high volume of reviews while maintaining accuracy, quality, and timeliness. Effective written and verbal communication skills are required to interact professionally with providers, clinical consultants, agency staff, and other stakeholders. The ability to exercise sound judgment, maintain confidentiality, handle sensitive information appropriately, and recognize when additional clinical review or consultation is necessary is required. The incumbent must be dependable, trustworthy, and able to organize and complete work independently with limited supervision while also collaborating effectively with others. Key competencies include integrity, independent judgment, accountability, reliability, accuracy, adaptability, and initiative. The position requires the ability to manage competing priorities, meet established deadlines and productivity expectations, and take ownership of assigned work and decisions

Physical Demands:

Must be able to remain sitting for prolonged periods at a desk and working on a computer.

Must be able to move or lift up to 15 pounds at various times.