Professional Services Compliance Liaison

Delta Dental Plan of Michigan • Okemos, MI

21h • Hybrid

About The Position

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation. At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level