Dental Consultant

The Dental Consultant is responsible for participating in Utilization Management for Delta Dental of Virginia and works closely with the Professional Review, Dental Director and Chief Dental Officer. This position is focused on claims review and will be partnered with the dental director. This position assists in developing dental policy and procedures consistent with Delta Dental’s mission to ensure a competitive position for the company. Location Candidates located more than 1 hour outside of our corporate office in Roanoke, VA and residing in the following states may be considered for remote work: FL, GA, ID, MD, NC, NE, SC, TN, VA, WI, WV Essential Functions The Dental Consultant is responsible for providing leadership and coordination of efforts between departments in the following activities as they related to Delta Dental of Virginia. Claims Administration responsibility for: The determination of dental necessity and appropriateness of treatment standards. This includes assisting in the development of dental policy and staff calibration practices. Providing recommendations on policy for efficient and effective benefit review processes which assure the compliance of providers and subscribers with the provisions of employer dental contracts. Providing recommendations to the Professional Review staff specific to claims determinations and interpretation of dental policy. Adjudicate special claims and benefit review requests in a timely manner. Administer other dental related issues impacted by Delta Dental’s policies or procedures. Responsible for the timely and accurate review of claims to achieve cycle-time and accuracy standards. Communicate with dental care providers as appropriate, regarding claim and benefit matters to resolve disputes on individual claims. May perform other functions as assigned. Qualifications/Education/Experience A degree from an accredited U.S. College of Dentistry (DMD or DDS) with a current dental license or eligibility for Virginia license to practice dentistry. Minimum of 5 years dental practice experience; two or more years of dental consulting experience is preferred and clean malpractice history. Evidence of regular Continuing Education course completion. Administrative or management experience preferred. Familiarity with current dental science, utilization review techniques, data/statistical analysis, practice protocols and ADA issues; ability to analyze data and make effective decisions; knowledge and understanding of healthcare insurance products, dental industry trends, and the administrative delivery of group products desirable. Ability to think and plan strategically for organizational success. Strong interpersonal and communication skills. Total Rewards Philosophy At Delta Dental of Virginia, we believe that More Smiles and Healthier People starts with our own team members. Our mission to create healthy smiles in the community is only possible when the people behind that mission feel supported, valued, and set up to thrive. We offer competitive base compensation and our robust benefits package is a true reflection of our values because we believe everyone deserves a healthy smile, starting with our own team. The salary range for this role is $86- $90 per hour. This range reflects base salary only; additional bonus and incentive opportunities are available. Placement within the range is commensurate with the skills, experience, and contributions each candidate brings to the role. #J-18808-Ljbffr