• Job Description

  Req#: JR100946
  Job Title:
  Professional Relations Research Specialist
  
  Number of Positions:
  1
  
  Location:
  DDMI_Michigan
  
  Location Specifics:
  Fully Remote
  
  Job Summary:
  
  Candidates must reside within a reasonable commuting distance of our Okemos office for team meetings, collaborative sessions, and training.
  
  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:
  
  To direct and assist in cases involving the resolution of dental benefit determinations and analysis of provider inquiries including claims, Record changes and discrepancies and Credentialing and Recredentialing updates submitted to Professional Relations.
  
  Primary Job Responsibilities:
  
  
  • Researches, analyzes, and resolves cases involving compliance issues including but are not limited to balance billing, non-delivery of care, quality of care, anti-fraud hotline, internal referrals, and appeals. Case research may include but is not limited to, contract review and analysis, data analysis, records audit, and interviews with external customers.
  • Communicates to internal and external customers to ensure understanding of the corporation's programs and procedures and in resolving claims processing problems.
  • Works directly with Provider Records, Customer Service, Focused Review and other departments to research current Record status, claims questions and appeals.
  • Prepares responses to dental claim inquiries so appropriate determinations can be finalized with correct procedure policies and bypasses in place, adjudicates claims, analyzes documents, and maintains claims records, as well as coordinates adjustments on difficult claims and inquiries.
  • Prepares documentation and claims for adjustments and works with Records and Customer Service to ensure adjustments are completed.
  
  
  Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
  
  #LI-Remote
  
  Minimum Requirements:
  
  Position requires an associate's degree in accounting, business administration, dental assisting or hygiene, or a related field and four years of experience in a position requiring knowledge of dental terminology, dental procedure codes, or dental office billing and record keeping practices within a provider office, administering dental benefit contracts within the insurance industry, or identifying, analyzing, and resolving compliance issues based on policies and procedures outside of the insurance industry. Will accept any suitable combination of education, training, or experience.
  
  Position also requires knowledge of word processing, spreadsheet, and database applications; strong verbal and written communication skills; strong analytical skills; the ability to work independently and as part of a team; the ability to manage multiple assignments with competing deadlines; and the ability to identify and resolve problems using independent judgment.
  
  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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