Job Title: Government Programs Specialist
Number of Positions: 1
Location: Okemos, MI
Location Specifics: Hybrid Position
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.
Position Description: To coordinate the implementation and maintenance of government program accounts and oversee system integration and reporting to ensure contractual obligations and regulatory requirements are met.
Primary Job Responsibilities: - Assists with new and existing client information including, but not limited to, new client system set-up, renewing client system set-up, review and provide feedback of CMS bid submissions, review of Health Plan or government agency provided benefit details, member and/or provider communications, mailings, and billing requirements.
- Establishes and identifies tasks and timelines to ensure all requirements are completed by the effective date of the contract.
- Provides administrative support to internal and external clients, including but not limited to general and government program related inquiries, claims history cross check, customer service requests and focused review requests..
- Assists in reviewing, updating, obtaining approval for, and implementing communication documents sent to members and/or providers.
- Assists with monitoring client eligibility and prior claims data and provides final approval of data entered into Roosevelt.
- Assists in coordinating departmental compliance for government program business.
- Assists in coordinating, preparing, and participating in internal, mock, and CMS audits.
- Reviews and aids in determining resolutions for production issues including, but not limited to, billing, claims payment, eligibility, government program system functionality, and client contracts.
- Completes required periodic or ad hoc government program monthly and quarterly reporting, including but not limited to, geo access reports, dentist directories, and ID card tracking.
- Assists with the creation, review, and update of departmental procedures.
- Participates in testing and end-user training for system functionality.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Minimum Requirements: Position requires a bachelor's degree with coursework in business administration or a related field and three years' administrative support experience in the areas of administering or processing customer information, reporting, and responding to customer inquiries. Will accept any suitable combination of education, training, or experience. Position requires intermediate knowledge of desktop software including spreadsheets, word processing, and presentation software; effective verbal and written communication skills. Experience within a health insurance industry, contract language, summary plan and certificate language, claims processing and/or knowledge of government programs or CMS related business preferred. 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.