The Dental Consultant is responsible for participating in Utilization Management for Delta Dental of Virginia and works closely with the Professional Review, Dental Director and Chief Dental Officer. This position is focused on claims review and will be partnered with the dental director. This position assists in developing dental policy and procedures consistent with Delta Dental’s mission to ensure a competitive position for the company.
This position will remain open to receive applications through July 24, at which time we will begin inviting qualified applicants to participate in the interview process.
Candidates located more than 1 hour outside of our corporate office in Roanoke, VA and residing in the following states may be considered for remote work: FL, GA, ID, MD, NC, NE, SC, TN, VA, WI, WV
The Dental Consultant is responsible for providing leadership and coordination of efforts between departments in the following activities as they related to Delta Dental of Virginia.
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Claims Administration responsibility for:
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The determination of dental necessity and appropriateness of treatment standards. This includes assisting in the development of dental policy and staff calibration practices.
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Providing recommendations on policy for efficient and effective benefit review processes which assure the compliance of providers and subscribers with the provisions of employer dental contracts.
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Providing recommendations to the Professional Review staff specific to claims determinations and interpretation of dental policy.
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Adjudicate special claims and benefit review requests in a timely manner. Administer other dental related issues impacted by Delta Dental’s policies or procedures.
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Responsible for the timely and accurate review of claims to achieve cycle-time and accuracy standards.
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Communicate with dental care providers as appropriate, regarding claim and benefit matters to resolve disputes on individual claims.
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May perform other functions as assigned.
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A degree from an accredited U.S. College of Dentistry (DMD or DDS) with a current dental license or eligibility for Virginia license to practice dentistry.
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Minimum of 5 years dental practice experience; two or more years of dental consulting experience is preferred and clean malpractice history.
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Evidence of regular Continuing Education course completion.
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Administrative or management experience preferred.
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Familiarity with current dental science, utilization review techniques, data/statistical analysis, practice protocols and ADA issues; ability to analyze data and make effective decisions; knowledge and understanding of healthcare insurance products, dental industry trends, and the administrative delivery of group products desirable.
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Ability to think and plan strategically for organizational success.
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Strong interpersonal and communication skills.
Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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Physical demands: While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; balance; stoop; talk or hear. Use of hands is required for such technological devices such as a computer, telephone and others. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. The employee will be required to travel (sometimes long distances) to attend required meetings.
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Work environment: The work is limited to the office environment with occasional trips to other office facilities or locations necessitating walking outdoors or driving. The noise level in the work environment is usually minimal.
Total Rewards Philosophy:
At Delta Dental of Virginia, we believe that More Smiles and Healthier People starts with our own team members. Our mission to create healthy smiles in the community is only possible when the people behind that mission feel supported, valued, and set up to thrive. We offer competitive base compensation and our robust benefits package is a true reflection of our values, because we believe everyone deserves a healthy smile, starting with our own team. The salary range for this role is $86.00 - $90.00 per hour. This range reflects base salary only; additional bonus and incentive opportunities are available. Placement within the range is commensurate with the skills, experience, and contributions each candidate brings to the role.
