Dental Quality Management Coordinator

Western Dental•Orange, CA

1d•Onsite

About The Position

The Grievance Coordinator is an in-office position, responsible for assisting with the preparation of dental records (charts and x-rays), opening new grievances, and managing payer and dental board complaints. This position ensures all grievances and appeals are processed in a timely manner and that data is entered accurately. The QM Coordinator plays a key role in maintaining member satisfaction, regulatory compliance, and quality improvement initiatives.

Requirements

Minimum of 1 year of experience in grievances, appeals, claims, or customer service issue coordination, preferably within dental or health insurance.
Familiarity with dental terminology, CDT codes, and dental claims processing preferred.
Must be willing to relocate or live in California for an in office role.
Strong analytical and investigative skills with excellent attention to detail.
Excellent written and verbal communication skills.
Working knowledge of dental benefits administration, utilization review, and provider relations.
Ability to manage multiple priorities and meet strict deadlines.
Proficiency in Microsoft Office and Adobe Acrobat.
Strong commitment to confidentiality, professionalism, and member advocacy.

Responsibilities

Receive, document, and acknowledge grievances and appeals within required timeframes.
Investigate complaints involving dental benefits, claims processing, provider services, and quality-of-care concerns, including research and follow-up with dental offices.
Prepare dental records, including patient and office history, dental ledgers, and clinical documentation.
Collaborate with internal teams, including the Grievance Coordinator and Sr. Manager of QM, to ensure proper handoff and resolution of grievances.
Respond professionally and accurately, using proper grammar, to entities submitting complaints.
Track and monitor open cases to ensure compliance with regulatory deadlines, including state Department of Insurance, CMS, payer guidelines, and NCQA standards.
Maintain detailed and accurate documentation in the grievance tracking system and prepare reports on trends and outcomes as requested.
Identify systemic issues or trends and recommend process improvements to enhance member, provider, and payer experiences.
Support audits, compliance reviews, and quality improvement initiatives as needed.
Educate teammates and others on grievance and appeals procedures to promote consistency and prevent recurrence of issues.
Perform additional duties as needed to support the department.