Dental Insurance Consultant (Licensed Dentist)

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 (Hybrid)

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" 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.&nbsp;<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="http://www.bcbsm.com/index/about-us/our-company.html" 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 />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

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Mid-level Manager

Competitive Total Compensation Package

Overview: <strong>Provide clinical dental expertise and recommendations to support growth of dental line of business and positive member and provider experiences for Blue Cross Blue Cross Blue Shield of Michigan (BCBSM).</strong>
Responsibilities: <ul> <li>Provide input into the development of dental policies, consultation in audit processes and support utilization review activity for cost management and fraud waste and abuse monitoring.</li> <li>Develop dental clinical policies and procedures and provide interpretation, recommendation, and review within impacted areas of organization and vendor partners.</li> <li>Provide clinical support and participate in utilization management, quality management, and care management programs in respective areas and identify opportunities for improvement and efficiency.</li> <li>Review fee schedule changes for impacts and risks and provide clinical guidance for annual CDT changes, including new codes coverage and clinical rules.</li> <li>Oversee claims appeals escalated from the UM Department or Complaints and Appeals Department.</li> <li>Work with/oversee provider engagement with internal and external partners to set expectations, establish process improvement, and resolve issues.</li> </ul> <p><strong><u>Additional Responsibilities</u></strong></p> <ul> <li>Serve as the subject matter expertise to clinical and non-clinical staff, including advising the sales team on how to educate them and respond to market noise.</li> <li>Develop clinical programs/community events and provide advisement for health promotion and education.</li> <li>Provide consultation as requested by the Corporate Financial Investigation area in conjunction with the audit staff.</li> <li>Seek knowledge and provide clinical opinions regarding changes in the healthcare arena, principles of cost containment, emerging dental trends, dental plan coverage, treatment delivery systems, dental technology, and treatment.</li> <li>Review and provide allowed amounts for accidental dental claims.</li> <li>Serve as liaison to the Michigan and American Dental Associations and other dental organizations.</li> <li>Serve as the liaison for the Governmental Program Healthy Kids Dental per the agreement with the State of Michigan.</li> <li>Promote the value of whole health with dentistry. Focus dental providers on their role and share the importance of oral/overall health connections through outreach, webinars, radio and in-person talks.</li> <li>Provide clinical and operational insight on new healthcare initiatives and legislation that impact oral health at the state and federal levels.</li> <li>Serve as the expert and clinical liaison between BCBSM and partners in the oral health space to ensure that the enterprise is represented as a clinical thought leader in the industry.</li> <li>Assist in establishing corporate and regional initiatives to enhance quality of care, reduce medical costs and achieve positive health outcomes.</li> <li>Engage proactively with dental practices in and out of the BCBSM network with onsite visits and timely communication so they understand how best to work with Blue Dental.</li> <li>Provide timely attention, resolution, and communication to escalated inquiries.</li> </ul>
Requirements: <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 assurance.</li> <li>Current Michigan Dental license required.</li> <li>Certification by the American Association of Dental Consultants preferred.<br />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.</li> </ul>