Rhsc
Compliance Liaison
Okemos, MI
Sponsorship not specifiedDetected 25 days ago
AuditingCommunicationProblem SolvingCritical ThinkingMicrosoft Office
About the role
- 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.
Responsibilities
- Researches, analyzes, develops, and provides updates and recommendations to management about policies, procedures, and quality compliance standards in all areas of Professional Services.
- Develops an understanding of all requirements under DDPA and state and federal laws that impact the Professional Services department.
- Performs quality control reviews and continuous monitoring on updates and changes within the Provider Records department; including but not limited to, provider system new adds, deletions, changes, updates, and verifying that credentialing is compliant with CMS and NCQA requirements.
- Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Requirements
- Position requires a bachelor's degree in business administration, public administration, or related field and three years related experience in quality management or internal/external compliance auditing standards.
Nice to have
- Position requires general knowledge of state and federal regulations
- effective verbal and written communication skills
- critical thinking and advanced problem solving skills
- experience working with Microsoft office
- ability to resolve complex problems and use independent judgment to make decisions
Benefits
- Serves as a liaison for Professional Services and works closely with the Compliance Officer and Quality Assurance Administrator to ensure compliance with internal Delta Dental and CMS compliance standards.
- Performs quality control reviews and continuous monitoring on claims processed within the Professional Services; including but not limited to, Dental Audit, Professional Review, and Focused Review.
Visa & Work Authorization
- out regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, he
This listing is sourced directly from Rhsc's careers page and normalized into a canonical job model.