Supervisor, Government Programs Provider Outreach

Job Summary: Job Title:

Supervisor, Government Programs Provider Outreach

Number of Positions:

1

Location:

Detroit, MI

Location Specifics:

Fully Remote

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

Plans, organizes, and oversees the administrative and technical functions of the Provider Outreach team to ensure corporate and departmental goals and objectives are met.

Primary Job Responsibilities

• Supervises the administrative and technical functions of the Provider Outreach team to ensure achievement of corporate strategies, goals, and objectives.
• Supervises and administers all Provider Outreach processes for business as assigned.
• Oversees Provider Outreach team case and claim processing; creates, defines, and enforces procedures and processes to ensure cases and claims are processed timely and accurately; ensures new business rules/case and claim routes are implemented, case and claim processing guidelines updated; and develops and prepares departmental reports and analyzes business processes and information.
• Oversees and ensures strict adherence to regulatory requirements for Government Program Provider Outreach communications; defines and enforces processes and procedures to ensure outreach communications are performed timely and accurately; and ensures new regulatory requirements are implemented and met accordingly.
• Serves as a subject matter expert for communication, case, and claims processing questions related to Provider Outreach.
• Interviews, hires, evaluates, supervises, and develops staff to ensure accountability for achievement of corporate, departmental, and individual goals and objectives.
• Trains staff and performs accuracy reviews of outreach communications, cases, and claims processed to ensure timeliness and accurate adjudication pursuant to departmental guidelines/standards, client contracts, provider agreements, state/federal laws, and regulatory requirements.
• Acts as a resource for staff and manages and maintains relationships with internal departments and other various external customers to provide provider outreach expertise and/or interpretation of processing guidelines for provider outreach claims, cases, and communications.
• Develops, monitors, and maintains monthly worklist and individual production and quality control across the Provider Outreach team to ensure internal objectives, performance guarantees, Service Level Agreements, and regulatory compliance are met.
• Participates in the development and implementation of short and long-term departmental strategies, goals, and objectives.
• Assists in the development and monitoring of the annual department budget for the Provider Outreach team.
  
  

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, criminal justice, communications, dental assisting, dental hygiene, or a related field and three years of experience in a position requiring knowledge of dental terminology, dental procedure codes, or dental office billing and record keeping practices within a provider office, administering dental benefit contracts within the insurance industry, or identifying, analyzing, and resolving compliance issues based on policies and procedures outside of the insurance industry. Will accept any suitable combination of education, training, or experience.

Position requires strong communication and interpersonal skills to effectively interact with healthcare providers and internal teams; advanced knowledge of the insurance industry, and/or dental claims billing/administration in a dental office setting, dental terminology, procedures, and dental insurance products; strong verbal and written communication skills, strong organizational and analytical skills; the ability to supervise multiple assignments with competing deadlines; and the ability to 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.