Professional Services Compliance Liaison

Delta Dental of Michigan•Okemos, MI

18h•Hybrid

About The Position

Develops, updates, and implements all Professional Services policies, procedures, and work instructions, as well as facilities the quality control program in order to remain in compliance with internal Delta Dental and state and federal compliance requirements.

Requirements

Position requires a bachelor's degree in business administration, public administration, or related field and three years related experience in quality management or internal/external compliance auditing standards.
Will accept any suitable combination of education, training or experience.
Position requires general knowledge of state and federal regulations
effective verbal and written communication skills
critical thinking and advanced problem solving skills
experience working with Microsoft office
ability to resolve complex problems and use independent judgment to make decisions

Nice To Haves

knowledge of dental terminology, procedures, dental insurance products, ETS, Provider System, Client and provider contracts and auditing experience preferred.

Responsibilities

Serves as a liaison for Professional Services and works closely with the Compliance Officer and Quality Assurance Administrator to ensure compliance with internal Delta Dental and CMS compliance standards.
Develops an understanding of all requirements under DDPA and state and federal laws that impact the Professional Services department.
Researches, analyzes, develops, and provides updates and recommendations to management about policies, procedures, and quality compliance standards in all areas of Professional Services.
Performs quality control reviews and continuous monitoring on claims processed within the Professional Services; including but not limited to, Dental Audit, Professional Review, and Focused Review.
Performs quality control reviews and continuous monitoring on updates and changes within the Provider Records department; including but not limited to, provider system new adds, deletions, changes, updates, and verifying that credentialing is compliant with CMS and NCQA requirements.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.