Job Title:

Business Rules Process and Policy 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 for all. 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

Administers procedure codes and related business rules to ensure that claims processing policies are in compliance with internal and external guidelines, customer contracts, and provider contracts on behalf of Delta Dental of Michigan (DDMI) and its affiliates as assigned.

Primary Job Responsibilities

• Partners with the Dental Director in analyzing and interpreting the American Dental Association (ADA) / Code on Dental Procedures and Nomenclature (CDT) procedure code and DeltaUSA processing policy revisions to determine the impact to our customer and provider contracts and business rules. 

• Organizes, plans, and conducts Policy and Claims Processing Committee meetings and the Delta Dental affiliate and customer meetings. 

•  Develops and maintains documents used to review and to capture decisions made by the Policy and Claims Processing Committee and Delta Dental affiliate and customer plans. 

• Organizes, tracks, and performs all revisions for the annual ADA/CDT procedure code and claims processing policy revisions.

• Develops and maintains user manuals and documents on behalf of other departments and affiliates/customer plans for claims processing and the administration of group contracts.

• Provides support to end users responsible for administering dental benefits and accurate claims processing.

•  Maintains procedure code and processing policy data in claims processing application.

• Performs and coordinates business rule changes/requirements with department so that all necessary changes are implemented within the required timeframe.

• Acts as a liaison between Business Project Development and other departments and customers regarding the DeltaUSA processing policies, procedure codes, and policies.

• Acts as a resource and subject matter expert for other departments and affiliate locations to ensure accurate claims processing and system routing based on approved guidelines.

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 or a related field and five years of experience with progressively more responsibility auditing or reviewing dental claims, administering group dental contracts, responding to dental benefit inquiries, or resolving dental benefit administration issues. Experience with either commercial group benefits or within the Medicare/Medicaid industry is preferred. One year of dental chairside assisting, or dental hygiene and/or administering customer and provider contracts is preferred.  Will accept any suitable combination of education, training, or experience. 

Position requires expert knowledge of dental terminology, ADA procedure codes, DeltaUSA processing policies and rationale, and dental benefit administration; advanced knowledge of claims processing policies, procedures, and systems; advanced knowledge of word processing, spreadsheet, database, and presentation applications; strong verbal and written communication skills; strong interpersonal skills; strong analytical skills; the ability to manage multiple projects with competing deadlines; and the ability to identify and resolve complex problems using independent judgment.

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.