Adult DBM-MCO Coordinator

Adult DBM-MCO Coordinator

Requirements

• Bachelor’s degree in business administration, healthcare administration, public health, dental hygiene or a related field
• Three years of experience utilizing analytical tools and software, dental claims billing or review, or dental software
• Advanced knowledge of dental terminology and dental procedures
• Experience working with word processing and spreadsheet software
• Strong verbal and written communication skills
• Strong organizational and analytical skills
• Ability to manage multiple assignments with competing deadlines
• Ability to resolve complex problems using independent judgment
• Travel of 10-25% throughout the state of Tennessee, and nationally as necessary

Responsibilities

• Oversees delivery of dental care and benefits management for adults and coordinates with managed care organizations (MCO)
• Coordinates with MCOs to ensure alignment on adult dental benefit offerings, network adequacy, and quality standards
• Develops and maintains a system for data exchange with the MCOs and the Contractor
• Coordinates care with DBM case managers and MCOs for all services
• Ensures effective dental care within the adult dental benefit parameters
• Conducts regular reviews and audits to ensure MCO and DBM compliance with Medicaid regulations and internal policies
• Supports the identification and implementation of quality improvement initiatives
• Supports other quality initiatives for Medicaid population
• Develops applicable reporting for MCO-DBM coordinated cases
• Coordinates with MCOs to identify medical facilities willing to partner on reserved operating room access time for dental services
• Maintains detailed records of each member case treated in the hospital or surgery center
• Facilitates communication and collaboration between MCOs and dental providers

Preferred Qualifications

• Previous experience working with health plans, insurance, or in healthcare settings is preferred