Compliance Liaison

Delta Dental Plan of Michigan, Inc.; Okemos (MI); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) savings plans

Tuition reimbursement or educational assistance

On-staff health coach and personal trainer

Eight hours of paid volunteer time

Job summary

Delta Dental Plan of Michigan, Inc. is seeking a Professional Services Compliance Liaison in Okemos, MI for a hybrid position. The role involves developing and implementing compliance policies, ensuring adherence to internal and external regulations, and performing quality control reviews. Candidates require a bachelor's degree and three years of relevant experience.

The position offers a comprehensive benefits package including medical, dental, vision coverage, and annual incentive opportunities, along with a culture of community involvement.

Qualifications

• 3 years related experience in quality management or compliance auditing.
• General knowledge of state and federal regulations.
• Knowledge of dental insurance products preferred.

Responsibilities

• Serve as a liaison for Professional Services with Compliance Officer.
• Develop understanding of DDPA and state/federal laws.
• Perform quality control reviews on claims processed.

Skills

Effective verbal and written communication skills

Critical thinking

Advanced problem solving skills

Experience with Microsoft Office

Knowledge of dental terminology

Education

Bachelor's degree in business administration or related field

Job description

Job Title

Professional Services Compliance Liaison

Number of Positions

1

Location

Okemos, MI

Location Specifics

Hybrid Position

Job Summary

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

Develops, updates, and implements all Professional Services policies, procedures, and work instructions, as well as facilities the quality control program in order to remain in compliance with internal Delta Dental and state and federal compliance requirements.

Primary Job Responsibilities

• Serves as a liaison for Professional Services and works closely with the Compliance Officer and Quality Assurance Administrator to ensure compliance with internal Delta Dental and CMS compliance standards.
• Develops an understanding of all requirements under DDPA and state and federal laws that impact the Professional Services department.
• Researches, analyzes, develops, and provides updates and recommendations to management about policies, procedures, and quality compliance standards in all areas of Professional Services.
• Performs quality control reviews and continuous monitoring on claims processed within the Professional Services; including but not limited to, Dental Audit, Professional Review, and Focused Review.
• Performs quality control reviews and continuous monitoring on updates and changes within the Provider Records department; including but not limited to, provider system new adds, deletions, changes, updates, and verifying that credentialing is compliant with CMS and NCQA requirements.
• Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Minimum Requirements

Position requires a bachelor's degree in business administration, public administration, or related field and three years related experience in quality management or internal/external compliance auditing standards. Will accept any suitable combination of education, training or experience. Position requires general knowledge of state and federal regulations; effective verbal and written communication skills; critical thinking and advanced problem solving skills; experience working with Microsoft office; ability to resolve complex problems and use independent judgment to make decisions; knowledge of dental terminology, procedures, dental insurance products, ETS, Provider System, Client and provider contracts and auditing experience preferred.

Benefits

Employees are offered a comprehensive benefits package that includes medical, dental and vision coverage, short- and long-term disability, life insurance, 401(k) savings plans, flexible spending accounts, and tuition reimbursement or educational assistance. Employees are also eligible for annual incentive compensation based on annual business goals. Additionally, employees receive eight hours of paid volunteer time each year, access to an on-staff health coach and personal trainer, plus many other perks.

Equal Opportunity Employer Statement

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. Delta Dental is an Equal Opportunity Employer.