Key Facts

Remote From:

Full time

English

Hard Skills

Network Service Assurance Provider Network Management Cross-Functional Collaboration Business Communication Analytics Recruitment Strategies Auditing Policy Development Provider Data Management Online Communication

Other Skills

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Microsoft Excel
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Microsoft Word
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Non-Verbal Communication
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Independent Thinking
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Time Management
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Teamwork
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Analytical Thinking
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Coaching

Roles & Responsibilities

Associate's degree in business administration, healthcare administration, or a related field, plus four years of experience identifying, analyzing, or resolving issues based on policies and procedures (or any suitable combination of education, training, or experience).
Proficiency with word processing and spreadsheet applications.
Strong verbal and written communication skills.
Strong analytical skills with the ability to manage multiple assignments and resolve complex problems using independent judgment.

Requirements:

Works closely with Sales, Legal and Compliance and Government Funded Programs to administer Medicaid and Medicare provider network requirements and network adequacy standards.
Conducts monthly and quarterly network adequacy audits for Medicaid and Medicare groups as required by CMS.
Develops departmental policies and procedures for Medicaid and Medicare business.
Administers Salesforce user support to Professional Services Representatives and collaborates with the Salesforce Administrator and IT staff to resolve provider data issues in Salesforce.

Delta Dental of Michigan

Insurance

About Delta Dental of Michigan

Delta Dental of Michigan began operations in 1957, and today with its affiliates, is one of the largest dental plan administrators in the country. 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. In addition to providing superior dental benefits, Delta Dental of Michigan and the Delta Dental Foundation are committed to investing in initiatives that support healthy, smart, vibrant communities for all. Follow the Delta Dental Foundation for their work on improving oral and overall health and health equity.

Company type: SME

Industry: Insurance

Founded: 2018

Company size: 501 - 1000

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Job description

Job Title:

Professional Services Reporting Specialist

Number of Positions:

Location:

Okemos, MI

Location Specifics:

Fully Remote

Job Summary:

Candidates must reside within a reasonable commuting distance of our Okemos, MI office for team meetings, collaborative sessions, and training.

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.

Job Summary:

Serves as liaison to other Delta Dental Plans, representing the Tri-State operation for new and existing DeltaUSA business activities; and monitors and audits provider network access and adequacy issues for Medicaid and Medicare business.

Primary Job Responsibilities:

Works closely with Sales, Legal and Compliance and Government Funded Programs division on the administration of Medicaid and Medicare business as it pertains to provider network requirements and network adequacy standards.
Conducts monthly and quarterly network adequacy audits for Medicaid and Medicare groups as required by CMS.
Develops departmental policies and procedures required for Medicaid and Medicare business.
Assists with special projects as appointed by the department director.
Assists in the development of recruitment strategies, researches, analyzes and generates various provider and group reports for DeltaUSA business to support provider network expansion or resolve disruption in the Tri-State territory, and orchestrates recruitment efforts based on the needs of internal and external customers.
Develops and generates earnings and county group report queries for recruitment and retention of dentists, and trains staff on the use of reports generated.
Develops a variety of documents, surveys, communications and mailings for DeltaUSA and Medicaid and Medicare business activity.
Assists with NPF audits as needed and all tasks associated with the annual initiative.
Administers Salesforce user support to Professional Services Representatives. Works with Salesforce Administrator and IT staff to resolve Provider data issues in Salesforce. Develops, generates and monitors a variety of reports from logged activities completed by the field representative.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

#LI-Remote

Minimum Requirements:

Position requires an associate's degree in business administration, healthcare administration, or a related field and four years of experience identifying, analyzing, or resolving issues based on policies and procedures. Will accept any suitable combination of education, training, or experience.

Position requires knowledge of word processing and spreadsheet applications; strong verbal and written communication skills; strong analytical skills; the ability to manage 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.