Key skills
Communication
About this role
Role Overview
- The Dental Director relies on dental background and reviews dental claims.
- Conduct clinical reviews associated with dental fraud, waste and abuse investigations and create recommendations.
- Stay up to date on all dental industry standards.
- Provide education and guidance for new data tools to review provider outliers.
- Coordinate investigations with law enforcement authorities and assemble evidence/documentation for successful adjudication.
- Conduct on-site audits of provider records ensuring appropriateness of billing practices.
- Prepare complex investigative and audit reports.
Requirements
- Doctor of Dental Surgery (DDS) degree or DMD
- A minimum of five years of experience in a clinical dentist office as a practicing dentist
- Must hold a clear and active license to practice dentistry (in any US state)
- Must be comfortable with data analysis/report interpretation
- Strong computer skills including MS Office desktop applications (Word, Excel, PowerPoint, Visio, Project)
- Demonstrated competency in written communication skills
- Solid understanding of process / workflow concepts
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
- Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
Benefits
- Benefits starting day 1 of employment
- Competitive 401k match
- Generous Paid Time Off accrual
- Tuition Reimbursement
- Parental Leave
- Work at Home Requirements