Professional Services Compliance Liaison

Job Title

Professional Services Compliance Liaison

1

Okemos, MI (Hybrid Position)

The role involves developing, updating, and implementing Professional Services policies, procedures, and work instructions to ensure compliance with internal and external regulations, including Delta Dental, CMS, and NCQA standards.

• Serves as a liaison for Professional Services and closely works with the Compliance Officer and QA Administrator to ensure compliance with internal Delta Dental and CMS standards.
• Develops an understanding of all requirements under DDPA and state and federal laws that impact the Professional Services department.
• Researches, analyzes, and provides updates and recommendations to management about policies, procedures, and quality compliance standards in all areas of Professional Services.
• Performs quality control reviews and continuous monitoring on claims processed within the Professional Services (e.g., Dental Audit, Professional Review, Focused Review).
• Performs quality control reviews and continuous monitoring for updates and changes within the Provider Records department (e.g., new adds, deletions, changes, updates, and credentialing accuracy with CMS and NCQA requirements).
• Performs other related assigned duties as needed to fulfill the Primary Job Responsibilities.

Position requires a bachelor’s degree in business administration, public administration, or related field and three years of related experience in quality management or internal/external compliance auditing. Position also requires general knowledge of state and federal regulations; effective verbal and written communication skills; critical thinking and advanced problem solving skills; experience working with Microsoft Office; ability to resolve complex problems and use independent judgment to make decisions;

knowledge of dental terminology, procedures, dental insurance products, ETS, Provider System, Client and provider contracts and auditing experience 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.