Associate Dental Consultant

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: compliance,analysis,consulting,code,values,claims,communication,analysis,knowledge,license,performance,experience,certification


Competitive Compensation and Benefits Package

Overview: Provide input into the development of dental policies, consultation in audit processes and support utilization review activity
Responsibilities: <ul> <li>Provide clinical dental expertise to the Blue Cross Blue Cross Blue Shield of Michigan (BCBSM) Utilization Review process.</li> <li>Review records and determine medical necessity billed correctly and meet the standard.</li> <li>Attend managerial level conferences and/or meetings and discuss audit findings with dental provider.</li> <li>Review Fee schedules changes for impacts and risks.</li> <li>Provide consultation as requested by the Corporate Financial Investigation area in conjunction with the audit staff.</li> <li>Offer expert testimony as requested by various BCBSM departments.</li> <li>Report identified edit and/or system processing errors for evaluation and correction.</li> <li>Make recommendations for dental policy and procedure changes and prepare articles for publication in digital and printed newsletters on topics that need to be communicated to dental providers.</li> <li>Review utilization analysis reports and provide recommendations or discuss with others in the department as appropriate.</li> <li>Actively seek knowledge regarding changes in the health care arena, principles of cost containment, treatment delivery systems, dental technology and treatment.</li> <li>Reviews and provides allowed amounts for accidental dental claims.</li> <li>CDT code updates to include rules, fees, updates sent to EDI, updates to vendor and medical teams.</li> <li>Liaison the Michigan and American Dental Associations and other dental organizations.</li> </ul>
Requirements: <div id="requirements" class="job-summary-section ng-scope"> <div> <div class="full-text ng-binding"> <ul> <li>Doctorate of Dental Surgery required.</li> <li>Ten (10) years experience in clinical practice and dental insurance claims review, audit, utilization review and quality</li> <li>assurance.</li> <li>Current Michigan Dental license required.</li> <li>Certification by the American Association of Dental Consultants preferred.</li> <li>Excellent analytical, organizational, problem solving, verbal and written communications skills.</li> <li>Working knowledge of technical aspects of clinical dentistry.</li> <li>Extensive knowledge of BCBSM claims review, and policies and procedures.</li> <li>Ability to evaluate dental research, make difficult decisions and communicate them in a timely manner.</li> <li>Proficient in current industry standard PC applications and systems.</li> <li>Other related skills and/or abilities may be required to perform this job. All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orienation, age, gender identity, protected veteran status or status as an individual with a disability.</li> </ul> </div> </div> </div>