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American Dental Association · 1 month ago

Manager Dental Benefits and Third-Party Payer Issues

Chicago, IL

Full-time

Hybrid

Mid, Senior Level

5+ years exp

The American Dental Association is a purpose-driven nonprofit with a dynamic staff culture. The Manager of Dental Benefits and Third-Party Payer Issues will lead operational efforts for the Council on Dental Benefit Programs, overseeing dental benefits initiatives and providing support for volunteer committees.

AssociationHealth Care

Work & Life Balance

Responsibilities

The Manager of Dental Benefits and Third-Party Payer Issues provides operational leadership for the ADA’s Council on Dental Benefit Programs

The role oversees all aspects of the Association’s dental benefits and third-party payer initiatives, including Council and program operations, policy development, and stakeholder engagement

It provides staff support for public and professional volunteer committees and oversees third-tier member service functions related to the Third-Party Payer Concierge Service

Qualification

Dental benefits administrationProgram managementHealthcare industry experienceClaim adjudication processesProvider network contractingM365 proficiencyAnalytical skillsDental Coding CertificationHealth benefits certificationCommunication skillsCollaboration skillsPresentation skillsFacilitation skillsSelf-starterResults-focusedWriting skills

Required

Bachelor's degree or experience in lieu of degree

5 years of experience (or 9 years in lieu of a degree) program management or operations in the healthcare, managed care, or insurance industry, including four years of experience in the dental industry

Experience engaging with external organizations or payers to resolve issues

Experience with direct experience in dental benefits administration or management

Comprehensive understanding of dental benefit plan design, administration, and reimbursement methodologies

Knowledge of claim adjudication processes, coordination of benefits, downcoding, bundling, and non-covered services policies

Familiarity with provider network contracting, fee schedules, utilization management, and prior authorization practices

Must have verbal communication, writing, analytical, facilitation, collaboration, presentation, a self-starter, results-focused skills

Proficiency in M365 (MS Office)

Travel twice per year, 1-3 nights per trip for attendance at CDBP or ADA meetings, industry conferences/events such as AADC, or other meetings as assigned

Position may require before or after hours work and/or may require weekend work

Preferred

American Association of Dental Consultants (AADC) Certification or Dental Coding or Reimbursement Certification (e.g. Dental Coding Consultant or Dental Benefit Specialist)

Certification in health or dental benefits administration, such as Certified Employee Benefit Specialist (CEBS), Health Insurance Associate (HIA)