Senior Payment Integrity Dental Analyst

SmartLight Analytics • Plano, TX

3d

About The Position

The Senior Payment Integrity Dental Analyst serves as a primary liaison between the organization, carriers, TPAs, and clients for dental payment integrity matters. This role is focused on carrier engagement, issue resolution, and professional representation of payment integrity findings, supported by a strong working knowledge of dental claims data and billing practices.

Requirements

• 5+ years of experience in dental payment integrity, dental claims analysis, or healthcare reimbursement.
• Direct experience engaging with carriers and TPAs, including leading or participating in calls.
• Strong understanding of dental billing workflows and CDT coding.
• Excellent written and verbal communication skills.
• Ability to interpret and explain claims data without performing advanced analytics.

Nice To Haves

• Prior experience specifically focused on dental fraud, waste, and abuse or improper payment investigations.
• Professional certifications such as: Certified Dental Coder (CDC) CPC, CCS, or similar coding certifications AHFI or CFE
• Experience working with commercial dental plans, TPAs, or self-funded employer plans.
• Knowledge of local, state, and federal regulations related to health and dental insurance.
• Experience in a dental provider or group practice environment.

Responsibilities

• Act as a subject-matter expert on calls with carriers, TPAs, and clients to discuss dental payment integrity findings and resolution paths.
• Professionally present and defend payment integrity conclusions, supported by claims data and clinical rationale.
• Review dental claims, billing patterns, and documentation to identify improper payments.
• Interpret claims data and investigative findings and translate them into clear explanations for non-technical audiences.
• Produce clear, defensible documentation suitable for carrier and TPA review.
• Collaborate with internal teams to align findings prior to external discussions.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed