Dental Policy Manager

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $78k - $106k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Support the accuracy and maintenance of assigned client dental payment policy sets by reviewing change requests, identifying potential impacts, and recommending appropriate updates within established guidelines • Conduct periodic and industry-update analyses for assigned clients using established review processes • Evaluate content changes, identify potential policy impacts, and recommend appropriate updates • Clearly understand and articulate new dental policy rules in an existing Decision Point and present policies to the Dental Director for client presentation • Assist in preparing payment policy documents for client presentation, coordinate review and approval with the Dental Director, and participate in client policy meetings • Serve as the client-facing representative and partner with Dental Clinical Leadership, Content Team, and Compliance • Analyze clinical, licensure, utilization-review, and compliance considerations and coordinate recommendations with subject-matter experts • Review and analyze client inquiries and change requests, apply decisions for affected policies, maintain information, and communicate effectively with clients • Resolve routine and moderately complex client policy inquiries within established parameters and escalate novel, high-risk, or precedent-setting matters • Provide standard policy guidance and recommend action based on established dental payment-policy standards • Analyze policy, claims, and reporting information from multiple sources; identify trends or discrepancies; and communicate findings and recommendations to internal and external audiences • Evaluate and document client-specific policy requirements, sensitivities, and approved exceptions • Coordinate assigned projects using project-management practices, including monitoring timelines, identifying risks, and communicating status • Apply working knowledge of dental policy, claims, inquiry, and reporting applications to evaluate information and support recommendations • Perform day-to-day responsibilities independently within established policies and procedures • Complete performance-review responsibilities, special projects, and other assigned duties

🎯 Requirements

• Bachelor’s Degree in relevant field or equivalent, such as a Dental Hygienist • Minimum 2 years of experience in dental claims, dental payment policy, dental coding, utilization management/review, payer operations, dental benefits administration, or a closely related field • Demonstrated knowledge of CDT coding, dental terminology, dental claim forms and data, dental reimbursement concepts, and common dental benefit and claim-adjudication practices • Certified Dental Coder or another relevant coding, compliance, utilization-management, or project-management credential • Knowledge of claims management billing systems is preferred • 2+ years’ experience in customer service or client management with a strong focus on healthcare setting • Knowledge of dental claims payment policy, processing, and reimbursement methodologies • Prior experience in developing dental payment policy edits preferred • Strong research capabilities and knowledge of ADA and CDT guidelines and other regulatory compliance guidelines and mandates, and dental payment policies • Knowledge of dental terminology • Clearly understands and articulates dental policies • Effective analytical and problem-solving skills • Professional with ability to properly handle confidential information • A track record of successful outcomes working within a collaborative team environment or highly matrixed structure • Strong interpersonal skills and the ability to work with on-site and remote cross-functional product teams and customers • Computer and technology literate with proficiency in MS Office Suite: Excel, Word, PowerPoint and Outlook • Willingness/availability to travel up to 15% is required • Ability to work with a high volume of transactions, effectively organize, prioritize and meet deadlines • Must be able to perform daily functions with a reasonable amount of direct supervision • Must be able to perform duties with or without reasonable accommodation • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance

🏖️ Benefits

• Medical, dental, vision, disability, and life insurance coverage • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti • Remote work arrangement • Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance provided by the candidate

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