NJ Licensed Staff Dentist (Insurance Claims Review)

Liberty Dental Plan; Shrewsbury (NJ); On-site; USD 130,000 - 160,000; Full time

Job summary

Liberty Dental Plan is seeking a NJ Licensed Staff Dentist to manage dental claims and ensure high-quality care. Responsibilities include clinical reviews, utilization management, and participation in quality improvement activities. Join a team dedicated to shaping the future of dental insurance.

Benefits

401(k) retirement benefits

100% employer-paid dental coverage

Affordable medical insurance

Generous vacation and sick leave policies

Tuition reimbursement

Qualifications

• 2 years experience in processing claims preferred.
• 4+ years experience as a practicing dentist.

Responsibilities

• Conduct clinical review of claims and pre-authorizations.
• Participate in Quality Management and Improvement activities.
• Conduct Peer-to-Peer calls to discuss utilization trends.

Skills

Clinical Dentistry

Utilization Management

Quality Improvement

Education

DDS/DMD Degree

Job description

NJ Licensed Staff Dentist (Insurance Claims Review)

Join to apply for the NJ Licensed Staff Dentist (Insurance Claims Review) role at Liberty Dental Plan

NJ Licensed Staff Dentist (Insurance Claims Review)

Join to apply for the NJ Licensed Staff Dentist (Insurance Claims Review) role at Liberty Dental Plan

Description

Join Liberty Dental Plan as We Shape the Future of Dental Insurance!

Liberty Dental Plan is looking for a New Jersey Licensed Staff Dentist to join our growing team! Unrestricted license or certification to practice dentistry in the State of New Jersey and the ability to obtain a license in the State of West Virginia REQUIRED.

The Staff Dentist will primarily be responsible for the Utilization Management and Utilization Review Programs and ensuring the timely oral health decision-making and adjudication of dental claims and prospective requests for dental services (referrals and pre-authorizations) across all lines of business including

Description

Join Liberty Dental Plan as We Shape the Future of Dental Insurance!

Liberty Dental Plan is looking for a New Jersey Licensed Staff Dentist to join our growing team! Unrestricted license or certification to practice dentistry in the State of New Jersey and the ability to obtain a license in the State of West Virginia REQUIRED.

The Staff Dentist will primarily be responsible for the Utilization Management and Utilization Review Programs and ensuring the timely oral health decision-making and adjudication of dental claims and prospective requests for dental services (referrals and pre-authorizations) across all lines of business including Commercial, Medicare Advantage and Medicaid programs to help ensure financial stability and quality of care. A staff dentist will be involved in state oral health programs of Liberty, as well as other clinical review activities and duties outlined below.

Job Summary Details

• Conduct clinical review of claims and pre-authorizations for all lines of business and/or markets as needed to ensure LIBERTY meets their contractual regulatory timeframes.
• Participate in all clinical trainings, calibrations and Interrater reliability testing while also meeting all required quality and calibration benchmarks required by LIBERTY and state/federal regulations.
• Participate and/or complete Quality Management and Improvement activities, DCM and SIU activities (provider site reviews/or consultations, utilization management and utilization review analysis, counseling calls, etc.) and recommend actions to resolve identified provider trends and treatment patterns.
• Conduct Peer-to Peer calls to discuss utilization trends, quality issues and trends in prospective and retrospective claims submissions.
• Conduct secondary reviews such as grievance and appeal review.
• Identify potentially unnecessary services in relation to care delivery settings.
• Identify potential quality issues and trends in prospective and retrospective claims submissions.
• Examine dental charts for focused audits of aberrant utilization and care delivery patterns.
• Occasional on-site chart review for the state provider network.
• Attend meetings of supervisory and administrative staff to discuss department operations, clinical findings and staff training needs.
• Use clinical expertise to make appropriate dental interpretations and decisions, as required.
• Develop and maintain subject matter expertise in LIBERTY dental benefit plans and applicable State Medicaid Programs. As requested, contribute to required regulatory reporting.
• Participate in Quality Improvement and Provider Credentialing Committees and provide input on appropriate resolution of member and/or provider grievances.
• Collect and evaluate data from Grievance, Peer Review, Public Policy, and the Credentialing Sub-Committee on a quarterly basis.
• Participate in enrollee Tele-dentistry visits to provide clinical assessment, evaluations, and recommendations based on dental need.
• May consult periodically with Dental Board-eligible and/ or certified specialist or academic specialist within the community to make informed decision for individual enrollees.
• The position description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee.
• Perform other duties as assigned.
  
  

Qualifications

Education/Experience

• DDS/DMD Degree Active, unrestricted license or certification to practice dental or related health profession in a state or territory of the United States of America in good standing (must pass credentialing - no probation or listed sanctions)
• 2 Years experience in processing claims in accordance with policy, including prior experience training peers preferred.
• 4+ Years experience as a practicing dentist
  
  

Specific Skills/Knowledge

• Knowledge of clinical dentistry procedure codes and generally accepted clinical and adjudication guidelines on medical necessity of proposed dental procedures.
• Demonstrated performance in managing oral health care cost and utilization management.
• In-depth knowledge of commercial and managed care delivery systems, reimbursement mechanisms, state regulatory and legislative landscape and quality improvement initiatives.
• Ability to examine and read dental radiographs and chart records.
• Ability to be successfully credentialed and re-credentialed by LIBERTY Dental Plan.
• Must comply with applicable federal and state statutes and regulations.
• Project management exposure with the ability to create and implement plans successfully.
• Computer literacy with the ability to easily acquire working knowledge of new system applications.
• Ability to apply alternate benefits where applicable, and consistent with plan guidelines and/or generally accepted professional protocols or guidelines.
• Ability to work in a team providing leadership and implementing the consensus or organizational required activities.
• Complete all necessary CE credits associated with maintaining your dental licensure.
• Additional state licensures may be needed to meet regulatory needs of the company.
  
  

Location

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

What Liberty Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

Our first-class benefits package supports employees and their dependents with:

• Competitive pay structure and savings options to help you reach your financial goals.
• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
• 100% employer-paid dental coverage for employees and eligible dependents.
• Vision insurance with low-cost premiums for employee-only coverage and dependents.
• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
• Flexible Spending Accounts for healthcare and dependent care expenses.
• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
• Long-term disability coverage.
• Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.
• Employee Assistance Program (EAP) to support mental health and well-being.
• Generous vacation and sick leave policies, with the ability to roll over unused time.
• 10 paid company holidays.
• Tuition reimbursement for eligible educational expenses.
• Remote or hybrid work options available for various positions.
  
  

Compensation

In the spirit of pay transparency, the base salary range for this position is $130,00 - $160,000, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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