Missouri Dental Director, DentaQuest - Part-Time
Sun Life•Kansas City, MO
•Hybrid
About The Position
Sun Life U.S. is seeking a part-time Missouri Dental Director to act as a clinical subject matter expert for internal entities and the state of Missouri. This role involves reviewing claims based on medical necessity, evaluating appeals, counseling providers, identifying aberrant utilization patterns, providing clinical support for provider outreach, and offering feedback on clinical policies. The position embraces a hybrid work model, requiring candidates to reside in Missouri and work approximately 20 hours per week.
Requirements
- Graduate of an accredited Dental School (D.D.S. or D.M.D)
- Maintain an unrestricted dental license in the state of Missouri
- Physically reside in the state of Missouri
- At least 5 years of clinical experience preferred
- 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
Nice To Haves
- Knowledge of general dentistry
- Public health or pediatric experience a plus
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 benefit and authorization requirements for plans and/or states, claims payment and 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 educational 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
- Generous vacation and sick time
- Market-leading paid family, parental and adoption leave
- Medical coverage
- Company paid life and AD&D insurance
- Disability programs
- Partially paid sabbatical program
- 401(k) employer match
- Stock purchase options
- Employer-funded retirement account
- Flexible, inclusive and collaborative work environment that supports career growth
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Part-time
Career Level
Senior
