Dental Analyst III – Part-time

Role Overview

• 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 such as the use of the algorithms or structured guidelines
• 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
• 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, which include providing explanation of coding rationale with little assistance
• 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 on changes to enhance the editing and efficiency as well as passing on client feedback
• 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 for claim review, appeals, pre-authorizations, and logics
• 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

Requirements

• 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, as well as four plus years’ work experience at Cotiviti and meets the responsibilities and performance requirements of a Dental Analyst II
• Coding Dental Certification (CDC) required
• Is proficient in current dental terminology (CDT) dental procedures, conditions, and treatment practices
• Is 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 with the ability to think logically and process sequentially with a high level of detailed accuracy and speed
• Demonstrated ability to meet or exceed assigned targets and deadlines consistently with minimal supervision
• Communicating with others to exchange information
• Assessing the accuracy, neatness and thoroughness of the work assigned

Benefits

• 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 with Cotiviti