What are the responsibilities and job description for the Dental Auditor position at Delta Dental of Michigan?
This is a remote position.
If and/or when they become effective, Delta Dental of Michigan is required to comply with President Biden's Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors and the Department of Labor's Occupational Safety & Health Administration's Emergency Temporary Standards (ETS). This includes compliance with federal COVID-19 vaccination requirements as well as any and all applicable masking, social distancing, and other workplace safety guidance.
As such, if and/or when the Executive Order and/or ETS become effective, Delta Dental of Michigan will require all employees, as a term and condition of employment, to demonstrate compliance by providing proof of vaccination, becoming vaccinated, or via an approved medical or religious accommodation in accordance with applicable laws and regulations and/or comply with other required workplace safety measures.
Delta Dental of Michigan, Ohio, and Indiana is a leader in dental benefits, plus so much more.
We improve oral health through benefit plans, advocacy and community support, and our corporate giving builds healthy, smart, vibrant and inclusive communities. We devote our time, talents and financial resources to improve oral and overall health, and we invest in initiatives that support youth, education, workforce and economic development.
We are a force for good-part of the reason why employees find working at Delta Dental fulfilling.Delta Dental companies nationwide comprise the Delta Dental Plans Association, which provides coverage to more than 80 million Americans and operates two of the nation's largest networks of participating dentists.For more, visit www.deltadentalmi.com and www.buildingbrighterfutures.com, and apply online at www.deltadentalmi.com/careers.
TYPICAL ASSIGNMENTS
- Analyzes, adjudicates, and processes dental claims so that clinical determinations can be finalized using policies, procedures, and bypasses.
- Reads, interprets, and compares radiographs and/or dental history with treatment plan
- Reviews member’s group coverage to determine type and level of benefits
- Pre and post-screens claims for dental consultants
- Uses system and other sources to obtain information needed to process claim determinations, including DeltaUSA processing policies, group contracts, provider agreements, and federal and state laws applicable to claims adjudication
- Determines payment amounts when appropriate
- Reviews, modifies and corrects claims in the system as needed, including claims that are not billable to the patient
- Sends requests to dental offices seeking additional claim information, using proper grammar and punctuation
- Calculates basic mathematical functions
- Operates office equipment, which may include a personal computer, calculator, copier, fax machine, etc.
- Maintains claims records and related departmental records and files
Bidding Requirements:
- Possess a high school diploma or equivalent
- Delta Dental approved dental assisting certificate OR one-year dental office chairside assisting
- Successful completion of Professional Services Dental Assessment (minimum of 85% accuracy)
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
