Job Title:

Professional Services Compliance Liaison

Number of Positions:

Location:

Okemos, MI

Location Specifics:

Hybrid Position

Job Summary:

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.

Position Description:

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.

Primary Job 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.

#LI-Hybrid

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

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

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