Requirements
Position requires one year of college, technical, vocational or business school with coursework in dental assisting or dental hygiene, business administration and composition and two years of related work experience. Previous Medicare and/or Medicaid experience is preferred. Will accept any suitable combination of education, training, or experience.
Position requires intermediate knowledge of word processing and spreadsheets; knowledge of dental terminology, procedures, insurance products, and claims processing; knowledge of procedure writing and training content development; ability to analyze and resolve complex problems; ability to identify, research and resolve customer complaints/issues; ability to handle multiple projects and deadlines and multitask; excellent verbal and written communication and organization skills; ability to work independently and make informed decisions quickly; and ability to work flexible hours including some weekends.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
Description
This is a remote position.
Delta Dental of Michigan, Ohio, and Indiana is a leader in dental benefits, plus so much more.
We improve oral health through benefit plans, advocacy and community support, and our corporate giving builds healthy, smart, vibrant communities for all. We devote our time, talents and financial resources to improve oral and overall health, and we invest in initiatives that support youth, education, workforce and economic development.
We are a force for goodpart of the reason why employees find working at Delta Dental fulfilling. Delta Dental companies nationwide comprise the Delta Dental Plans Association, which provides coverage to more than 83 million Americans and operates two of the nation's largest networks of participating dentists. For more, visit www.deltadentalmi.com and www.vibrantcommunities.com , and apply online at www.deltadentalmi.com/careers .
Job Summary:
To provide day-to-day support to internal and external customers by resolving difficult claims, inquiries, grievances and appeals to ensure accurate benefits administration and delegation. Analyzes contacts to ensure accuracy, which includes, but not limited to, listening to calls, reviewing call logs, working one-on-one with customer service staff and/or other internal departments. Develops and conducts Government Programs department employee training on department systems and processes and the application of corporate policies, procedures, and guidelines.
Primary Job Responsibilities:

1. Serves as primary CSR support to assist with detailed interpretation of dental policies, procedure codes, claims processing, Medicare Advantage/Medicaid compliance guidelines and policies and procedures. Researches, analyzes, adjudicates and makes appropriate determinations on difficult claims and inquiries.
2. Develops, coordinates and conducts new-hire onboarding and training, as well as periodic refresher and training on new functionality and processes. Researches and implements training programs using various methods of instruction.
3. Identifies, creates and maintains government programs training and support specialist processes and procedures.
4. Prescreens claims and inquiries for the Professional Review and Focused Review departments.
5. Communicates with other departments to identify and troubleshoot potential processing and/or system issues.
6. Collaborates with department management, quality assurance specialists and reporting specialists to identify process improvements, department trends and training needs.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.