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