Director of Clinical Audits and Peer Reviews

Overview

We are looking for a Director of Clinical Audits and Peer Reviews to join our compliance team. This individual will report to the Compliance Director and assist the Compliance Department. Develop and execute a comprehensive clinical audit and peer review strategy aligned with organizational quality and compliance goals.

• Conduct internal audits, peer audits, and internal investigations
• Manage and respond to external audits (insurance companies, regulatory agencies, state dental boards, legal entities)
• Oversee external insurance payment audits
• Identify compliance risks and implement corrective action plans
• Present compliance workflows and documentation standards

• Design and select procedures for peer audit review
• Train and educate auditors on audit protocols and software tools
• Analyze peer audit results and present findings to clinical leadership
• Facilitate follow-up and resolution of issues identified during audits

• Participate in clinical review of patient and internal complaints
• Support investigations involving clinical care and documentation
• Work with Quality Assurance Committee of the Oral Health Board to address issues identified during clinical reviews
• Participate in Credentialing committee workflows and meetings for clinical review of re-credentialing matters
• Serve as expert for state and federal dental practice act regulations, including allowable and prohibited duties by clinical role

• Oversee infection control compliance across supported practices
• Monitor Direct Unit Water Line (DUWL) testing and weekly spore testing completion
• Troubleshoot sterilization and testing issues with offices
• Provide guidance on sterilization, disinfection, and PPE standards

• Provide onboarding education for new hires
• Deliver ongoing training on compliance, infection control, and vendor tools
• Support adoption of organizational protocols and best practices

• Monitor key performance indicators (KPIs) related to audits and infection control
• Prepare and deliver quarterly reports to executive leadership
• Collaborate with executive and operational leadership, including the Chair of the Oral Health Board, Vice Presidents of Operations and Clinical Operations, and Regional Directors of Operations.
• Advocate for company-wide clinical standards

• At least eight (8) to ten (10) years experience in a clinical dental environment
• Comprehensive knowledge of dental procedures and CDT coding
• Understanding of insurance billing practices and documentation requirements
• Knowledge of state Dental Practice Acts and scope of practice for dental healthcare personnel (DHCP)
• Ability to analyze audit findings and provide actionable recommendations
• Ability to interpret radiographic images
• Working knowledge of clinical dentistry across specialties
• Understanding of standard of care and risk exposure
• Knowledge of CDC and ADA infection control guidelines
• Knowledge of OSHA Bloodborne Pathogen (BBP) Standard and workplace safety requirements
• Understanding of best practices for sterilization, disinfection, and dental operatory setup
• Knowledge of regulatory compliance requirements and inspection readiness
• Strong presentation and communication skills
• Proficiency in Open Dental (OD) reporting and MS Office, especially PowerPoint, Word and Excel
• Attention to detail; very organized
• Ability to interact with people at all levels of the corporate structure, prioritize and handle numerous competing demands in a high-volume, fast-paced working environment
• Ability to work independently and complete job responsibilities without significant oversight

• Comprehensive Benefits:
  Including 401(k)
• Paid Time Off:
  Competitive PTO that grows with your career
• Career Growth:
  Opportunities for continuing education and development
• Exciting Work Environment: A supportive atmosphere that celebrates individuality and teamwork, allowing you to thrive

We embrace diversity and are committed to creating an inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, color, ancestry, religion, sex, sexual orientation, gender identity, age, national origin, disability, veteran status, or any other legally protected characteristic.