Dental Policy Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist in ensuring the accuracy and upkeep of designated client dental payment policy sets by evaluating change requests, recognizing potential impacts, and proposing suitable updates within established protocols.

• Perform regular analyses and industry updates for assigned clients utilizing established review methodologies.

• Assess content modifications, identify possible policy implications, and recommend necessary updates.

• Clearly comprehend and communicate new dental policy guidelines within an existing Decision Point, and present these policies to the Dental Director for client presentations.

• Aid in the preparation of payment policy documents for client presentations, coordinate review and approval with the Dental Director, and participate in meetings regarding client policies.

• Act as the client-facing representative, collaborating with Dental Clinical Leadership, the Content Team, and Compliance.

• Examine clinical, licensure, utilization-review, and compliance issues, and coordinate recommendations with subject-matter experts.

• Review and analyze client inquiries and change requests, apply decisions for impacted policies, maintain information, and effectively communicate with clients.

• Resolve routine and moderately complex client policy inquiries within established guidelines and escalate novel, high-risk, or precedent-setting issues.

• Provide standard policy guidance and suggest actions based on established dental payment-policy standards.

• Analyze policies, claims, and reporting data from various sources; identify trends or discrepancies; and communicate findings and recommendations to both internal and external stakeholders.

• Assess and document client-specific policy requirements, sensitivities, and approved exceptions.

• Manage assigned projects using project-management practices, including monitoring timelines, assessing risks, and communicating progress.

• Utilize a working knowledge of dental policy, claims, inquiries, and reporting applications to evaluate information and support recommendations.

• Independently perform daily responsibilities within established policies and procedures.

• Complete performance reviews, special projects, and other assigned tasks.

⛳️ Requirements

• Bachelor’s Degree in a relevant field or equivalent, such as a Dental Hygienist.

• A minimum of 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.

• Proven 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 credential in coding, compliance, utilization management, or project management.

• Familiarity with claims management billing systems is preferred.

• Over 2 years of experience in customer service or client management, particularly in a healthcare environment.

• Understanding of dental claims payment policies, processing, and reimbursement methodologies.

• Prior experience in developing dental payment policy edits is preferred.

• Strong research skills and familiarity with ADA and CDT guidelines, as well as other regulatory compliance requirements and dental payment policies.

• Knowledge of dental terminology.

• Ability to clearly understand and articulate dental policies.

• Strong analytical and problem-solving abilities.

• Professional demeanor with the capability to manage confidential information appropriately.

• A history of successful outcomes while working within a collaborative team environment or a highly matrixed structure.

• Excellent interpersonal skills and the ability to collaborate with both on-site and remote cross-functional product teams and clients.

• Proficient in computer and technology use, especially with MS Office Suite: Excel, Word, PowerPoint, and Outlook.

• Willingness and availability to travel up to 15% is required.

• Ability to handle a high volume of transactions, effectively organize, prioritize tasks, and meet deadlines.

• Must be capable of performing daily functions with a reasonable amount of direct supervision.

• Must be able to perform duties with or without reasonable accommodation.

• Must have a dedicated, secure workspace.

• Must ensure high-speed internet access/connectivity and maintain an office setup.

🏝️ Benefits

• Medical, dental, vision, disability, and life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays each year.

• 17-27 days of Paid Time Off (PTO) annually, depending on specific level and length of service with Cotiviti.

• Remote work arrangement.

• A dedicated, secure work area with high-speed internet access/connectivity and office setup and maintenance provided by the candidate.