United Spinal Association Jobs

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.