Dental Fraud and Abuse Specialist

DELTA DENTAL OF VIRGINIA

14h • Hybrid

About The Position

The Dental Fraud & Abuse Specialist is expected to work as a member of a Dental Fraud and Abuse team working closely with the Dental Director. This team will be expected to interact with every internal department of the organization to detect external fraud and abuse. The Dental Fraud & Abuse team is expected to analyze aberrant dental practice patterns as well as any other potential fraud schemes.

Requirements

• This position requires a degree in dental hygiene in addition to an x-ray license and analytical skills related to clinical data.
• Qualified candidate must be a dental hygienist with at least 8 years hands-on clinical experience in the dental office.
• This position must demonstrate the ability to comprehensively review dental office records, interpret all types of radiographs to compare and verify dental procedures performed in the dental office with those procedures submitted for claim payment and to identify potential areas of abuse.
• The position requires excellent written, analytical, verbal and communicative skills.
• Candidate must have a valid Virginia driver’s license as travel is required to dental offices throughout Virginia to perform audit of patient and other office records.
• Demonstrated experience leading people and getting results through others.
• Ability to think and plan strategically for organizational success.
• Strong interpersonal and communication skills

Nice To Haves

• Preferred candidates will have a minimum of 2 years’ experience with the business aspects of the dental office.

Responsibilities

• Responsible for detecting and deterring fraud and abuse by investigating claims data and dental office records of our subscribers.
• Researches patient charts, radiographs, periodontal charting, lab records, and any additional clinical and billing information as needed including appointment records that may be used to identify and to detect potential fraud.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 51-100 employees