Experienced Dental Consultant and former private practice Dentist
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Experienced Dental Consultant and former private practice Dentist with 30+ years of combined clinical, insurance, and practice management expertise. Extensive background in dental claims review, radiographic interpretation, treatment necessity evaluation, fraud prevention, peer-to-peer provider consultation, and complex case analysis. Proven ability to assess high-volume dental insurance claims while ensuring compliance with clinical guidelines, regulatory standards, and fair coverage determinations.
Strong knowledge of restorative, periodontal, prosthodontic, implant, and cosmetic dentistry procedures gained through both clinical practice and insurance consulting experience. Recognized for balancing clinical precision, policy compliance, and operational efficiency in complex dental consulting environments.
Dental Consultant - MetLife Insurance Company
(1998-01)
Review 160–200 daily Federal VIP (government employee) and commercial dental insurance claims to determine treatment necessity, coverage eligibility, and benefit approval using MetLife clinical standards. Interpret provider-submitted clinical explanations and supporting evidence to determine consistency with policy requirements and accepted standards of care. Conduct peer-to-peer consultations with providers requesting reconsideration or clarification of prior authorization and claim determinations.
Verify accuracy and validity of clinical information on claims and implement company protocols to help prevent fraud and abuse.
Unit by verifying whether billed procedures were completed and identifying suspicious provider activity or questionable documentation. Analyze radiographic imaging, treatment narratives, periodontal charting, CT scans, and intra-oral photography to validate diagnoses and treatment appropriateness. Evaluate dentist explanations and patient cases for pre-defined services, such as crowns, bridges and surgery, to ensure appropriateness and fairness of insurance coverage.
Dentist / Practice Manager - Joan M. Haluska, DDS
(1986-01 - 2001-12)
Founded, owned, and operated a private dental practice delivering comprehensive dental care focused on patient health, prevention, and education. Delivered restorative, periodontal, cosmetic, and general dental services including cleanings, veneers, dentures, implant restorations, bleaching, and extractions. Directed all aspects of business operations and financial affairs, including budgeting, payroll, purchasing, legal/regulatory compliance.
Oversaw and directed daily administrative operations, such as patient billing, insurance claims, patient record keeping, accounts payable, purchasing and patient appointments/scheduling.
Doctor of Dental Surgery - Dentistry - Loyola University of Chicago Dental School
Bachelor of Science - Biology, Chemistry Minor - Loyola University of Chicago
