Iowa Dental Director, DentaQuest

Sun Life•Des Moines, IA

3d•Hybrid

About The Position

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK. Candidates must reside in the state of Iowa. The opportunity: The Dental Director acts as a clinical subject matter expert for both internal entities and for the state of Iowa. Their clinical expertise may be called upon reviews claims based on medical necessity, in accordance with market contracts, evaluate appeals, counsel providers, identify providers with aberrant utilization patterns, provide clinical support for provider outreach, and provide feedback on clinical policies. How you will contribute: Facilitate educational trainings for dental providers. Represent DentaQuest in a professional manner at all times when interacting with clients, management, employees, the provider community, dental associates, and other key stakeholders. Adhere to all DentaQuest policies, processes and procedures. Identify and recommend process and productivity improvement opportunities. Establish and maintain an understanding of dental program administration, including, but not limited to: benefit and authorization requirements for plans and/or states, claims payment and the denial process, and a business understanding of ASO and Risk relationships Develop a strong knowledge base and overall understanding of state and federal dental regulations. Proactively alert DentaQuest staff of potential state regulatory changes impacting dental benefits/administration. Act as a DentaQuest liaison to the provider community, offering educations sessions associated with our dental programs. Proactively identify and participate in activities, programs, and speaking engagements associated with Medicaid and Medicare Dental Programs Identify and recommend regional community related activities and events (e.g. Health Fairs, Dental Screenings, Back to School Programs, etc.) DentaQuest can participate in to further our mission. Establish and maintain an understanding of DentaQuest’s Oral Health Wellness and Outreach Programs. Review dental cases and represent DentaQuest at fair hearings, as needed or directed. Establish and maintain strategic relationships with regional dental associations and key stakeholders for the purpose of solidifying new business and/or maintaining existing business. Recruit qualified providers for DentaQuest networks as needed or directed. Perform other duties as assigned

Requirements

Graduate of an accredited Dental School (D.D.S. or D.M.D)
Maintain an unrestricted dental license in the state of Iowa
Physically reside in the state of Iowa
At least 5 years of clinical experience preferred

Nice To Haves

Knowledge of general dentistry
Public health or pediatric experience a plus
Efficient PC skills
Ability to use analytical/presentation tools such as Excel and PowerPoint.
Organizational and time management skills
Ability to work with a team and independently to complete assigned tasks without supervision
Ability to make independent determinations on all types of dental claims
Excellent written and verbal communication skills
Ability to distinguish between multiple market benefits
Ability to prioritize and organize multiple tasks
Ability to remain organized with multiple interruptions
Networking and Negotiation skills required
Ability to travel as needed
Required to attend additional training as requested/deemed necessary

Responsibilities

Facilitate educational trainings for dental providers.
Represent DentaQuest in a professional manner at all times when interacting with clients, management, employees, the provider community, dental associates, and other key stakeholders.
Adhere to all DentaQuest policies, processes and procedures.
Identify and recommend process and productivity improvement opportunities.
Establish and maintain an understanding of dental program administration, including, but not limited to: benefit and authorization requirements for plans and/or states, claims payment and the denial process, and a business understanding of ASO and Risk relationships
Develop a strong knowledge base and overall understanding of state and federal dental regulations.
Proactively alert DentaQuest staff of potential state regulatory changes impacting dental benefits/administration.
Act as a DentaQuest liaison to the provider community, offering educations sessions associated with our dental programs.
Proactively identify and participate in activities, programs, and speaking engagements associated with Medicaid and Medicare Dental Programs
Identify and recommend regional community related activities and events (e.g. Health Fairs, Dental Screenings, Back to School Programs, etc.) DentaQuest can participate in to further our mission.
Establish and maintain an understanding of DentaQuest’s Oral Health Wellness and Outreach Programs.
Review dental cases and represent DentaQuest at fair hearings, as needed or directed.
Establish and maintain strategic relationships with regional dental associations and key stakeholders for the purpose of solidifying new business and/or maintaining existing business.
Recruit qualified providers for DentaQuest networks as needed or directed.
Perform other duties as assigned

Benefits

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.
Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.
Enjoy a flexible, inclusive and collaborative work environment that supports career growth.
We’re proud to be recognized in our communities as a top employer.
Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.

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