Dental Review Analyst (Registered Dental Hygienist)

Summary Job Description: This position coordinates daily activities which includes, but is not limited to, the interpretation and application of established policies as well as new policies relating to services and procedures covered under Health Plan Dental programs. The incumbent acts as lead dental reviewer and as an advisor to all areas regarding dental review issues (senior level). This position utilizes dental expertise and knowledge to assist in the computer analysis of dentist practice patterns and to identify dentists submitting claims for payment that do not comply with corporate policy. Essential Accountabilities Level I • Interprets issues and applies coverage policy to effectively review claims for dental necessity, legitimacy of charges and interpretation of procedures. Refers unusual claims to Dental Consultant for ruling. Identifies policy/procedures/pricing, which need modification and communicates proposed solutions(s) to correct. • Acts as dental review advisor to all areas of the Corporations for policy interpretation, codes, dental interpretation, etc (Sr. level). Is knowledgeable of mandates for medical/dental coverage specific to NY state for accidental injury coverage and congenital anomaly. • Participates in activities reflecting Dental Review activity such as procedure coding development and fraud and abuse. Monitors utilization, cost and quality of services rendered against projections and standards, provides rationale for variance and suggests corrective plans. Identifies plan members and providers in noncompliance with plan policies, procedures and protocols and suggests corrective action. • Sits on various task forces and committees as Dental Review representative. • Assists in the development of training programs for claims personnel, dentists, dental assistants and other related personnel as needed. • Keeps abreast of developments germane to the function by attendance at meetings, seminars, workshops, etc. • Maintains consistent benchmarks for claim review volume and accuracy. • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. • Regular and reliable attendance is expected and required. • Performs other functions as assigned by management. Level II (in addition to Level I Accountabilities) • Represents Department Leadership at meetings. • Trains and mentors Level I employees. • Effectively engages in special projects across internal business partner areas. Note Minimum Qualifications: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities. All Levels • Registered Dental Hygienist with current license required with a minimum of three years practical experience in an office environment. • A minimum of six months on-the-job training is required to become familiar with procedures, policies, protocol, etc. • Must possess strong analytical capabilities to identify billing practices that are not in accord with dental review guidelines. • Familiarity with computer analysis desirable. • Must have thorough knowledge of company policy and procedures and have the ability to recognize fine lines of distinction between similar, complex procedures. • Must be able to establish an effective liaison with other departments and periodically interact with dentists and their representatives. • Exhibits the ability to work independently and handle confidential information with discretion. • Good written and oral communication skills required. • Must be an effective team player. Level II (in Addition To Level I Qualifications) • Minimum of five years practical experience in an office environment. • A minimum of two years on-the-job training is required to become familiar with procedures, policies, protocol, etc. • Task oriented with ability to prioritize and balance multiple initiatives and job duties. • Exhibits strong organizational and planning skills. Ability to define or identify problems and prioritizes impact or corrective action/implementation to drive execution. Physical Requirements In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s) Level I: Grade E2: Minimum $60,410 - Maximum $96,081 Level II: Grade E3: Minimum $60,410 - Maximum $106,929 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Apply tot his job