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Billing & Eligibility Manager
Provides daily supervision and leadership to Delta Dental’s Billing and Eligibility Department. Responsible for group enrollment and eligibility processes. Ensures client billing and payments are handled in an accurate and timely manner. Conducts desk audits of staff to ensure quality processes. Responsible for all aspects of staff performance. Serves on the management team and actively participates in internal cross-departmental projects.
Provides Oversight for the Following Department Functions:
- Processes client payments
- Creates financial adjustments to the automated system to reflect accurate accounts receivable reporting
- Communicates with clients
- Collects past due balances
- Performs audits of group accounts and staff desk audits
- Conducts timely and comprehensive performance reviews including counseling and coaching
- Develops the staff through training and job assignments
- Conducts hiring when needed
- Represents DDVA at various client and confernece meetings
- Plans, tests, trains staff and implements process and system projects
Requirements:
Successful candidate works in a customer oriented environment to manage staff and complete deliverables in a timely manner. The candidate must possess strong knowledge of accounts receivable and collections. Must have excellent verbal and written communication and customer service skills. Self starter, able to manage multiple priorities simultaneously.
The position requires a Bachelors degree or equivalent in Accounting, Business or related field with 3+ years of management experience in an office setting. Preference also is for candidates with insurance industry experience. EOE. Drug-Free Work Environment. Please submit all resumes, cover letters, and salary requirements to: jobs@deltadentalva.com.
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Dental Auditor
Job Summary:
Reviews claims with the submitted diagnostic material to make proper benefit determination based on the group contract and DeltaUSA and departmental established guidelines. Responsible for clearing queues and pending claims for additional information. Forwards claims to dental consultant for review based on established guidelines.
Job Responsibilities: - Reviews diagnostic material (i.e. X-rays, periodontal charting) to determine benefits.
- Refers claims to dental consultant for review when diagnostic material does not appear to support the procedure requested.
- Follows DeltaUSA guidelines and departmental guidelines for claims processing.
- Refers claims to the fraud and abuse department for providers with suspicious patterns on claim submissions.
- Reports to Clinical Professional Services Manager
Qualifications:
5+ years of dental experience. The ability to read X-rays and prior dental assisting or dental hygiene experience required. Preference will be given for individuals with prior insurance background. An employee in this position performs work in an office setting. This employee must have the ability to read written materials, write, follow oral and written instructions, use a PC and perform other support duties, with or without reasonable accommodation. The job requires the ability to follow established procedures with moderate decision-making.
EOE. Drug-Free Work Environment.
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Dental Fraud Analyst
Delta Dental of Virginia, a leader in dental benefits, is in search of a Dental Fraud Analyst. The candidate of choice will be willing to travel throughout the state of Virginia to dental offices for audits, review radiographs, research patient claims and lab records and compare with the information in our system.
Candidate will also educate and advise providers of correct billing procedures and document accordingly. Candidate will also assist the department in educating others in potential indicators as well as general research for the detection of possible fraudulent practices. Provides input on computerized fraud detection system and other duties as assigned.
5 years hands-on clinical experience as a Dental Hygienist is preferred. Computer experience is a plus as well as experience with billing procedures and insurance claims filing. X-ray certified. 2 year college degree and valid driver’s license required.
Position in Roanoke, VA.
EOE. Drug-Free Work Environment.
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Senior Programmer Analyst
Reviews, analyzes, and modifies programming systems including encoding, testing, debugging and documenting programs. Requires a very high level of knowledge and experience involving Microsoft and Oracle technologies and strong programming skills in Oracle PL/SQL programming. Strong skills and experience in trouble shooting Oracle back-end systems, including troubleshooting of performance issues. Proficient in Microsoft technologies include VB6 and C# .Net programming. Individual should demonstrate an experience that involves working in projects following Agile methodology. Prepares functional process charts and documentation to describe the existing or proposed operations and designs detailed record and form layouts.
Bachelor's degree in computer or process engineering (or related field) plus 5 years experience or Master's degree plus 2 years experience.
40 hrs/week, M-F.
Equal Opportunity Employer.
Drug-Free Work Environment.
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