Under direction, to perform dental hygiene auditing and monitoring of the dental contract administered by the Organized Health Systems Division; and to do other related work.
Typical Tasks Assists in the planning, development and preparation of the dental operations manual and dental fiscal intermediary audit criteria; assists in the auditing and monitoring of the claims processing system of the dental fiscal intermediary; monitors and evaluates the claims processing system and recommends modifications; determines feasibility of operating procedures and methodology essential to appropriately implement State laws, regulations and guidelines; participates in research, analyzes statistical information and prepares reports pertinent to the promulgation of utilization, quality and technical dental norms and standards; assists in the development and implementation of dental policies and operating procedures; participates in the development, review and auditing of claim samples; assists in the duplication of radiographs as required in the auditing of claim samples; works independently and proficiently in handling complex and difficult assignments; advises professional unit chief on contract negotiations, priority schedules and staffing for projects; keeps informed on advancements in dental hygiene and capitated insurance programs; and does other work as required.
Possession of legal requirements to practice as a Dental Hygienist as determined by the California Board of Dental Examiners. andExperience: Two years of experience interpreting X-rays as a licensed Dental Hygienist.
Knowledge of: Principles, practices and techniques of dental hygiene; dental diseases (dental caries and periodontal disease), etiology, and the necessity of immediate treatment; types and funding for dental health insurance programs; current practices and methods of dental health insurance programs; public and private health administration; X-ray interpretation and techniques.
Ability to: Work with multidisplinary program staff in dental program management in coordinating services and implementing programs; interpret, apply and recommend changes in regulations, guidelines and operating instructions; analyze situations accurately and take effective action; meet and deal tactfully with the public; prepare technical papers and reports; reason logically and creatively; develop and evaluate alternatives; exercise resourcefulness; analyze data and present ideas and information effectively both orally and in writing.
Special personal characteristics: Possession of a high degree of originality and effectiveness in person-to-person relationships which result in cost savings and program effectiveness; possession of a valid California driver's license; willingness to travel as a regular part of the work.