Clinical Reviewer, Dental Hygienist

Devoted Health

. Perform first-level clinical reviews of dental claims and pre-treatment estimates using established clinical guidelines, policies, and delegated authority .

Posted 11/6/2026full-timeRemote • United StatesMid-LevelSenior💰 $58,000 - $75,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical dental reviews, including ADA CDT coding, dental terminology, and documentation standards. Proficient in analyzing dental claims and radiographs while maintaining compliance with HIPAA and organizational policies.

Highest-signal resume keywords

Registered Dental Hygienist (RDH) LicenseADA CDT Coding KnowledgeClaims-Processing Systems ProficiencyDental Insurance Claims Review ExperienceAnalytical and Problem-Solving Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewDental TerminologyRadiograph InterpretationClinical Documentation StandardsClaims ApprovalEvidence-Based GuidelinesUtilization ManagementWorkflow ImprovementsDocumentation AccuracyTreatment Record Evaluation

Soft Skills

Attention to DetailOrganizational SkillsCommunication Skills

Tools & Technologies

Electronic Health RecordsClaims-Processing SystemsDigital ToolsAI/LLM Tools

Certifications & Qualifications

Active Registered Dental Hygienist (RDH) License

Industry Keywords

Dental ClaimsMedicare AdvantageManaged CareHIPAA ComplianceClinical Guidelines

About the role

Key responsibilities & impact

Perform first-level clinical reviews of dental claims and pre-treatment estimates using established clinical guidelines, policies, and delegated authority
Approve claims meeting clinical, contractual, and documentation requirements
Evaluate radiographs, dental charting, narratives, treatment records, and claim histories using evidence-based guidelines and clinical expertise
Refer complex cases, potential denials, or adverse benefit determinations to Dental Advisors or designated clinical authorities for final determination
Identify required documentation, provide clear processing instructions, and document review findings accurately in claims systems
Apply ADA CDT coding knowledge, dental terminology, clinical documentation standards, and contractual provisions
Identify and escalate unusual practice patterns, utilization trends, potential fraud, waste, abuse concerns, policy gaps, or workflow issues
Collaborate with Dental Advisors, Claims, Provider Relations, and team leads to support operations and provider communications
Maintain compliance with HIPAA, privacy standards, organizational policies, and regulatory requirements
Work a five-day, eight-hour schedule totaling 40 hours per week, with shifts between 8:00 AM–8:00 PM ET and weekend and holiday rotation coverage

Requirements

What you’ll need

5+ years of clinical experience as a dental hygienist in a private practice or comparable dental healthcare setting
Active Registered Dental Hygienist (RDH) license or relevant clinical dental credential in good standing
Strong working knowledge of ADA CDT coding, dental terminology, dental procedures, and clinical documentation
Demonstrated ability to read and interpret dental radiographs, charting, clinical narratives, and treatment records
Excellent analytical, organizational, communication, and problem-solving skills with high attention to detail
Proficiency with claims-processing systems, electronic health/dental records, and standard digital tools
Experience with technology-enabled workflow improvements, particularly with AI/LLM tools
Prior experience in dental insurance claims review, utilization management, or health plan clinical operations, ideally within a Medicare Advantage or managed care setting

Benefits

Comp & perks

Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above
Parental leave program
401K program