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Director, Dental Policy

Company: Delta Dental of California
Location: Rancho Cordova
Posted on: May 16, 2020

Job Description:

#LI-SH1

AT DELTA DENTAL WE:
PROMOTE ACCOUNTABILITY, INTEGRITY AND COLLABORATION: Our employees are collaborative, self-aware, and ethical. It is our expectation to do the right thing and follow through on commitments.
FOSTER PROFESSIONAL DEVELOPMENT: Our employees take ownership of developing themselves and others through coaching, mentoring and providing/being open to constructive feedback and identifying learning opportunities.
VALUE CUSTOMERS AND CULTIVATE POSITIVE EXPERIENCES: Our employees take time to build rapport with customers, while anticipating and exceeding their needs to ensure positive outcomes.

If you think this sounds like you, let s chat. We would love to tell you more!

Follow us @lifeatDDins on Instagram, lifeatDDins on Facebook, @lifeatDDins on Twitter

ABOUT DELTA DENTAL
Delta Dental covers more Americans than any other dental benefits provider. As an employee you ll take part in our mission to become the trusted health partner by collaborating with our communities and employees to reimagine and deliver new possibilities in an ever-changing environment. Our Enterprise Strategy focuses on pillars of Growth and Diversification, supported by the platforms of Culture and People, Process and Technology. Our employees take pride working for a purpose-driven organization and live our values of Trust, Service, Excellence and Innovation.

We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation s largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.

Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
At Delta Dental, our strategy is only as strong as the people who execute it! We are hiring individuals that are not just right for today but also for our future. We have built a foundation of high-trust by treating all people with dignity, making and keeping commitments, and consistently striving to do the right thing. Our leaders optimistically share future possibilities to inspire and motivate others toward their full potential. We expect our employees to find ways to embrace positive change, be curious and challenge the status quo, and provide solutions to unmet problems. Joining Delta Dental means joining a culture focused on fostering development, building genuine connections, recognizing each other s strengths and sharing in successes.

The Director of Dental Policy is responsible for establishing, interpreting and coordinating dental processing policy in accordance with regulations and contractual agreements between Delta Dental and the State of California as well as overseeing the activities of the dental professional. This position leads a team of Dental Consultants and ensures timely processing of Treatment Authorization Requests (TARS).

How you will make an impact:

* Oversees the dental policy functions to ensure work is completed in a timely and accurate manner as defined in division goals.

* Promotes a constructive work environment.

* Directs staff, including: determining staffing needs, setting goals, interviewing, selecting, coaching, and evaluating the performance of all direct reports.

* Ensures continuous education of staff and works with department and/or enterprise trainer to develop written training materials and procedures.

* Develops annual department and project budgets; identifies variances and takes corrective action as appropriate.

* Develops processing policies that adhere to regulations and state contract terms.

* Communicates policy decisions to department staff, working with them to adhere to standard operating policies and procedures and to achieve goals.

* Oversees Dental Policy and related committees.

* Reviews and resolves complaints, grievances and appeals cases that cannot be resolved by staff.

* Reviews cases of suspected fraud, abuse and poor quality of care.

* Makes determinations on corrective action, suspension, or termination of provider agreements.

* Performs miscellaneous duties as assigned.

What we look for:

* Doctor of Dental Surgery or Doctor of Dental Medicine with a current California dental license and California Dental Association membership.

* A minimum of 8 years clinical dentistry and claims processing and/or quality assessment experience.

* A minimum of 4 years supervisory experience.

* Extensive knowledge of health care industry and dental procedures codes and nomenclature.

* Excellent organizational/time management and project management skills and multi-tasking abilities.

* Strong analytical skills to identify and evaluate business solutions.

* Strong management skills to effectively manage department activities.

* Knowledge of clinical dentistry with ability to evaluate quality of treatment performed.

* Knowledge of Delta Dental products, policies, claims, eligibility and underwriting guidelines.

Benefits and perks:

* 12 days starting vacation plus 12 holidays and your birthday off!

* Multiple medical insurance options: 100% paid or low cost premiums

* 100% paid dental insurance

* 100% paid vision insurance

* Onsite gym and/or gym discount and fitness incentive

* Culture of learning: substantial tuition reimbursement to improve your skills

* Career growth: we love promoting from within

* Strong commitment to work/life balance

* Technology allowance

* Social responsibility and volunteer opportunities

Keywords: Delta Dental of California, Rancho Cordova , Director, Dental Policy, Executive , Rancho Cordova, California

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