Manager Dental Benefits and Third-Party Payer Issues

American Dental Association•Chicago, IL

27d•Hybrid

About The Position

It all starts with purpose. We are a purpose-driven nonprofit with a dynamic staff culture. With a meaningful purpose, motivated staff, and excellent benefits, working here will definitely have you smiling! The ADA’s headquarters is located just steps from Chicago’s Magnificent Mile and close to public transportation. With more than 400 colleagues, the ADA Staff are some of the most talented people in the Chicago, Washington D.C., and Maryland area. We were named a Top Workplace by the Chicago Tribune in 2019 and 2021! Come join our team! Job Responsibilities: The Manager of Dental Benefits and Third-Party Payer Issues provides operational leadership for the ADA’s Council on Dental Benefit Programs. The role oversees all aspects of the Association’s dental benefits and third-party payer initiatives, including Council and program operations, policy development, and stakeholder engagement. It provides staff support for public and professional volunteer committees and oversees third-tier member service functions related to the Third-Party Payer Concierge Service.

Requirements

Bachelor's degree or experience in lieu of degree
5 years of experience (or 9 years in lieu of a degree) program management or operations in the healthcare, managed care, or insurance industry, including four years of experience in the dental industry
Experience engaging with external organizations or payers to resolve issues
Experience with direct experience in dental benefits administration or management
Comprehensive understanding of dental benefit plan design, administration, and reimbursement methodologies
Knowledge of claim adjudication processes, coordination of benefits, downcoding, bundling, and non-covered services policies
Familiarity with provider network contracting, fee schedules, utilization management, and prior authorization practices
Must have verbal communication, writing, analytical, facilitation, collaboration, presentation, a self-starter, results-focused skills
Proficiency in M365 (MS Office)
Travel twice per year, 1-3 nights per trip for attendance at CDBP or ADA meetings, industry conferences/events such as AADC, or other meetings as assigned
Position may require before or after hours work and/or may require weekend work

Nice To Haves

American Association of Dental Consultants (AADC) Certification or Dental Coding or Reimbursement Certification (e.g. Dental Coding Consultant or Dental Benefit Specialist)
Certification in health or dental benefits administration, such as Certified Employee Benefit Specialist (CEBS), Health Insurance Associate (HIA)

Responsibilities

The Manager of Dental Benefits and Third-Party Payer Issues provides operational leadership for the ADA’s Council on Dental Benefit Programs.
The role oversees all aspects of the Association’s dental benefits and third-party payer initiatives, including Council and program operations, policy development, and stakeholder engagement.
It provides staff support for public and professional volunteer committees and oversees third-tier member service functions related to the Third-Party Payer Concierge Service.