PT - Dentist - Detroit, MI

Name of Organization: Blue Cross Blue Shield of MI

Type of Opportunity: Dentist
Type of Specialist: Insurance Consultant

City, State: Detroit, MI

Hours: Part-Time

Description of Opportunity: Provide clinical dental expertise and recommendations to support growth of dental line of business and positive member and provider experiences for Blue Cross Blue Cross Blue Shield of Michigan (BCBSM).

Provide input into the development of dental policies, consultation in audit processes and support utilization review activity for cost management and fraud waste and abuse monitoring.

Develop dental clinical policies and procedures and provide interpretation, recommendation, and review within impacted areas of organization and vendor partners.

Provide clinical support and participate in utilization management, quality management, and care management programs in respective areas and identify opportunities for improvement and efficiency.

Review fee schedule changes for impacts and risks and provide clinical guidance for annual CDT changes, including new codes coverage and clinical rules.

Oversee claims appeals escalated from the UM Department or Complaints and Appeals Department.

Work with/oversee provider engagement with internal and external partners to set expectations, establish process improvement, and resolve issues.

Name of Contact: Christen Lieb
Website: https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/job/12436/?utm_medium=jobshare&utm_source=External+Job+Share