Occ. Code 6602100

 

DENTAL SERVICES REVIEW ASSISTANT 1, GRADE 15                                        

6602100

DENTAL SERVICES REVIEW ASSISTANT 2, GRADE 19

6602200   

 

New York State Department of Civil Service

 

Classification Standard

 

BRIEF DESCRIPTION OF CLASS SERIES

 

Positions in this series participate in and conduct dental[MA(1]  reviews and audits of Medicaid dental service providers and recipients in order to identify potentially fraudulent and abusive practices. 

 

These positions are located in the Department of Health and the Office of the Medicaid Inspector General.

 

DISTINGUISHING CHARACTERISTICS

 

DENTAL SERVICES REVIEW ASSISTANT 1: full performance level; under the general direction of a Dental Services Review Assistant 2, conducts medical reviews and audits of Medicaid dental service providers and recipients; and, makes referrals for recoupments or investigations.

 

DENTAL SERVICES REVIEW ASSISTANT 2: supervisory level; under the general direction of higher level staff, supervises multiple Dental Services Review Assistants 1 and contract clinical staff engaged in medical reviews and audits of Medicaid dental service providers and recipients.

 

ILLUSTRATIVE DUTIES

 

DENTAL SERVICES REVIEW ASSISTANT 1

 

·       Review dental services requests for medical appropriateness prior to authorization of the services.

 

·       Research and respond to inquiries and complaints from providers and recipients related to dental prior approvals and other issues.

 

·       Review and assess whether dental care and services rendered were medically necessary and appropriate based on review of x-rays, dental plans, and historical medical records.

 

·       Analyze dental charts to determine if required documentation supports billed services and meets quality of care provisions of the Medicaid program.

 

·       Monitor provider billing and procedures to identify potentially fraudulent and abusive practices, and to ensure that recommended corrective action plans have been implemented.

 

·       Compile and maintain a provider listing for audit consideration based on referrals or complaints from patients, the Attorney Generals Office, and other State agencies.

 

·       Prepare written responses for administrative fair hearings, and testify as an expert witness at administrative appeal hearings.

 

·       Participate in dental research-related projects.

 

DENTAL SERVICES REVIEW ASSISTANT 2

 

·       Perform all of the duties and responsibilities of Dental Services Review Assistant 1.

 

·       Review and resolve the more difficult requests for dental services, as referred by Dental Services Review Assistants 1.

 

·       Oversee dental research and provider targeting for dentists, dental groups, and dental clinics, including assisting in the building of criteria to process or pend dental claims.

 

·       Provide recommendations to support the development and revision of Medicaid policy.

 

·       Prepare provider review summaries and referrals, along with supporting documentation, for action based on Medicaid rules, regulations, policies, and guidelines. 

·       Utilize professional dental expertise to provide an analysis of dental providers practice in response to allegations of inappropriate practice or performance. 

·       Communicate orally and in writing with the dental provider community, legal staff, independent peers, and other agencies or stakeholders, as necessary, to contribute to projects, audits, or investigations. 

 

·       Perform the full range of supervisory duties such as approve leave and track time and attendance; identify staff development needs; evaluate staff performance; and complete performance evaluations.

 

MINIMUM QUALIFICATIONS

 

DENTAL SERVICES REVIEW ASSISTANT 1

 

Non-competitive: current registration as a licensed Dental Hygienist in New York State and two years of experience in dental hygiene practice; OR graduation from a school of dentistry*.

 

DENTAL SERVICES REVIEW ASSISTANT 2

 

Non-competitive: current registration as a licensed Dental Hygienist in New York State and three years of experience in dental hygiene practice; OR graduation from a school of dentistry* and one year of dental services experience.

 

*Individuals completing dental programs outside of the United States must have completed a program accredited by the World Health Organization.

 

Date:  5/18

 

 

NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe.  Standards cannot and do not include all of the work that might be appropriately performed by a class.  The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written.  Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.

 

 

 

 

 

 

 

 

 

 

 

 


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