Dental Auditor

Job Summary: Job Title:

Dental Auditor

Number of Positions:

1

Location:

Okemos, MI

Location Specifics:

Fully Remote

Job Summary:

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.

Typical Assignments:

• Analyzes, adjudicates, and processes dental claims so that clinical determinations can be finalized using policies, procedures, and bypasses.
• Reads, interprets, and compares radiographs and/or dental history with treatment plan
• Reviews member’s group coverage to determine type and level of benefits
• Pre and post-screens claims for dental consultants
• Uses system and other sources to obtain information needed to process claim determinations, including DeltaUSA processing policies, group contracts, provider agreements, and federal and state laws applicable to claims adjudication
• Determines payment amounts when appropriate
• Reviews, modifies and corrects claims in the system as needed, including claims that are not billable to the patient
• Sends requests to dental offices seeking additional claim information, using proper grammar and punctuation
• Calculates basic mathematical functions
• Operates office equipment, which may include a personal computer, calculator, copier, fax machine, etc.
• Maintains claims records and related departmental records and files
  
  

Minimum Requirements:

Bidding Requirements:

• Possess a high school diploma or equivalent
• Delta Dental approved dental assisting certificate OR one-year dental office chairside assisting
• Successful completion of Professional Services Dental Assessment (minimum of 85% accuracy)
  
  

The company will provide equal employment and advancement opportunity within the context of its unique business environment without 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, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.