Dental Fraud and Abuse Specialist

Delta Dental of Virginia; Roanoke (VA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Annual Incentive Plan

Comprehensive insurance coverage

Tuition reimbursement

Generous Holiday/PTO offerings

Health and Wellness programs

Job summary

A dental insurance provider in Virginia is seeking a Dental Fraud & Abuse Specialist to join their team. Responsibilities include investigating claims data and patient records to detect fraud, along with collaborating with various internal departments. Candidates must hold a degree in dental hygiene, possess an x-ray license, and have at least 8 years of clinical experience in dental settings. Excellent analytical and communication skills are essential for this role, which also involves travel throughout Virginia for audits.

Qualifications

• Must be a dental hygienist with at least 8 years of clinical experience.
• Experience with business aspects of a dental office is preferred.
• Ability to review records and interpret radiographs to detect fraud.

Responsibilities

• Detect and deter fraud by investigating claims data.
• Research patient records to identify potential fraud.
• Interact with multiple departments to analyze dental practices.

Skills

Analytical skills

Strong interpersonal skills

Excellent written communication

Verbal communication skills

Ability to think strategically

Education

Degree in dental hygiene

X-ray license

Job description

The Dental Fraud & Abuse Specialist is expected to work as a member of a Dental Fraud and Abuse team working closely with the Dental Director. This team will be expected to interact with every internal department of the organization to detect external fraud and abuse. The Dental Fraud & Abuse team is expected to analyze aberrant dental practice patterns as well as any other potential fraud schemes.

Essential Functions

• Responsible for detecting and deterring fraud and abuse by investigating claims data and dental office records of our subscribers.
• Researches patient charts, radiographs, periodontal charting, lab records, and any additional clinical and billing information as needed including appointment records that may be used to identify and to detect potential fraud.

Qualifications/Education/Experience

• This position requires a degree in dental hygiene in addition to an x-ray license and analytical skills related to clinical data.
• Qualified candidate must be a dental hygienist with at least 8 years hands‑on clinical experience in the dental office.
• Preferred candidates will have a minimum of 2 years’ experience with the business aspects of the dental office.
• This position must demonstrate the ability to comprehensively review dental office records, interpret all types of radiographs to compare and verify dental procedures performed in the dental office with those procedures submitted for claim payment and to identify potential areas of abuse.
• The position requires excellent written, analytical, verbal and communicative skills.
• Candidate must have a valid Virginia driver’s license as travel is required to dental offices throughout Virginia to perform audit of patient and other office records.
• Demonstrated experience leading people and getting results through others.
• Ability to think and plan strategically for organizational success.
• Strong interpersonal and communication skills.

Delta Dental of Virginia offers a comprehensive compensation package in addition to your annual base salary which include the following:

• Annual Incentive Plan available to all team members.
• Comprehensive Insurance Coverage (including Medical, Dental, Vision, Pharmacy benefits, Life Insurance and AD++).
• Voluntary Benefits (such as Critical Illness/Accident, Pet Insurance and Legal Resources).
• Employee Assistance and Health and Wellness programs (including an onsite gym!).
• 24/7 On-Demand TextCare: Text a board-certified medical provider, for you and your loved ones, 24/7 - and get a provider response in under 5 minutes.
• Generous Holiday/PTO offerings, with an extra paid day off during your birthday month.
• Flexible Spending Accounts and Health Savings Accounts.
• Comprehensive 401(k) plan with matching and Profit Sharing program.
• Tuition Reimbursement / Educational Assistance.