[Hiring] Dental Analyst III @Cotiviti

Role Description

Perform Dental daily review/audits on client data for completeness and accuracy of coding, utilizing coding background to ensure appropriateness for reimbursement when providing recommendations on clinical claims to the client:

• Makes certain the requirements for Current Dental Terminology (CDT), ADA and other related concessions are met.
• Performs duties according to structured algorithms or other written guidelines.
• Handles moderately complex issues, refers all medical necessity procedures to higher-level staff for approval or denial.
• Possesses solid working knowledge of subject matter.

Responsibilities include:

• Perform daily audits on client data for completeness and accuracy of coding utilizing coding background to ensure appropriateness for reimbursement.
• Does not interpret or evaluate medically necessary clinical information but performs duties according to structured algorithms or other written guidelines.
• Only licensed personnel provide oversight and follow-up for clinical related questions or issues.
• State Licensure (renew license, submit new applications, respond to attestations, other special requests).
• URAC (renew accreditation when due, responds to all special requests).
• Train Dental New Hires.
• Audit New Hires 100%.
• Train/Assist training clients on Nucleus.
• Train on Client Imaging systems.
• Monthly Quality Audit of Analyst.
• May provide leadership, coaching, and/or mentoring to a subordinate group.
• May act as a lead or first-level supervisor.
• Coding Dental Certification (CDC) is required.
• Respond to provider appeals of non-clinical issues.
• Respond to client logics and record reviews of non-clinical issues.
• Assess and respond to client/provider educational needs.
• Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations.
• Contribute to DCA by providing feedback to the Management and Development team.
• Participates on the Quality Committee as required.
• Mentor other analysts in learning the rules, guidelines of coding, and the application of company policies and procedures.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Exceeds all Dental Claims Accuracy department yearly goals.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

Qualifications

• High School Diploma or GED required.
• Minimum of three years’ work experience in a clinical role in the dental office, as a Dental Assistant or Dental Hygienist.
• Four plus years’ work experience at Cotiviti and meets the responsibilities and performance requirements of a Dental Analyst II.
• Coding Dental Certification (CDC) required.
• Proficient in current dental terminology (CDT) dental procedures, conditions, and treatment practices.
• Proficient in dental claims payment policy and processing, specifically CDT and limited CPT.
• Ability to conduct training to both internal staff and clients in an efficient and effective manner.
• Excellent computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.
• Exceptional problem solving and analytical skills with excellent written and verbal communication.
• Demonstrated ability to meet or exceed assigned targets and deadlines consistently with minimal supervision.
• Ability to communicate with others to exchange information.
• Ability to assess the accuracy, neatness and thoroughness of the work assigned.

Requirements

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• No adverse environmental conditions expected.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Benefits

• Base compensation ranges from $30.00 to $37.25 per hour.
• Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week.
• Cotiviti offers a competitive benefits package including:
• Medical, dental, vision, disability, and life insurance coverage.
• 401(k) savings plans.
• Paid family leave.
• 9 paid holidays per year.
• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service.