Job Title: Dental Auditor
Department: Quality Management (QM)
Position Type: Full-time
Compensation: $600 per day
Location: California (must hold an active CA dental license)
Summary The Dental Auditor ensures clinical quality, regulatory compliance.. This role conducts clinical audits and reviews, identifies risks and trends, and partners with internal teams and providers to drive corrective actions and continuous improvement.
Key Responsibilities
- Perform clinical audits of dental records, and utilization to assess compliance with policies, CADP standards, state/federal regulations, and payer requirements.
- Evaluate medical necessity, coding accuracy (CDT), documentation quality, and adherence to evidence-based guidelines.
- Support readiness for external reviews and accreditation surveys; maintain audit tools, checklists, and SOPs.
- Provide provider education and feedback to improve documentation, coding, and clinical quality.
- Maintain strict confidentiality and data security in accordance with HIPAA and company policies.
Required Qualifications
- Licensed Dentist in California with an active status
- CADP-certified auditor (preferred). If not currently certified, must obtain certification promptly upon hire.
- Strong knowledge of dental benefit design, CDT coding, utilization management, and quality improvement principles.
- Excellent analytical, documentation, and report-writing skills.
- Strong communication skills with the ability to deliver clear feedback to providers and cross-functional partners.
Preferred Qualifications
- Minimum 2 years of experience working with dental plans (payer, DSO, or managed care setting).
- Experience with CADP standards,
- Familiarity with fraud/waste/abuse detection, root cause analysis, and corrective action planning.
- Experience training or educating providers on documentation and coding best practices.
Work Schedule and Environment
- Full-time, Monday-Friday
- Primarily office-based, with potential travel for provider site audits within California.
Performance Metrics
- Accuracy and completeness of audit findings and reports.
- Timeliness of audits and follow-up validations.
- Reduction in error rates and repeat findings.
- Provider satisfaction with education and feedback.
- Compliance with CADP and regulatory standards.
