Job description
HCA Solutions is seeking a qualified Dental Hygienist for the OMAP - Bureau of Program Integrity in Harrisburg, PA!

This is a full-time contracted position that offers long term placement and W-2 employment.

Shift available: 8am-4pm (30 minute lunch)

This is a remote / hybrid position that will require 8 weeks minimum onsite for training and will release to remote based on employee performance.

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 providers 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 Departments action.
Attend relevant meetings and participate in workgroups, as assigned.
Minimum Qualification

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
Benefits

11 paid holidays
2 weeks PTO
Medical/Dental/Vision/Supplementals
401k
Paid STD