Manager Dental Benefits and Third-Party Payer Issues

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The Manager of Dental Benefits and Third-Party Payer Issues provides operational leadership for the ADA’s Council on Dental Benefit Programs. The role oversees all aspects of the Association’s dental benefits and third-party payer initiatives, including Council and program operations, policy development, and stakeholder engagement. It provides staff support for public and professional volunteer committees and oversees third-tier member service functions related to the Third-Party Payer Concierge Service.

• Bachelor's degree or experience in lieu of degree
• 5 years of experience (or 9 years in lieu of a degree) in the dental industry
• 3 years of program management or operations
• Experience engaging with external organizations or payers to resolve issues
• Experience in healthcare, managed care, or insurance industry including direct experience in dental benefits administration
• Comprehensive understanding of dental benefit plan design, administration, and reimbursement methodologies
• Knowledge of claim adjudication processes, coordination of benefits, down coding, bundling, and non-covered services policies
• Familiarity with provider network contracting, fee schedules, utilization management, and prior authorization practices
• Must have verbal communication, writing, analytical, facilitation, collaboration, presentation, a self-starter, results-focused skills
• Proficiency in M365 (MS Office)
• Travel twice per year, 1-3 nights per trip for attendance at CDBP or ADA meetings, industry conferences/events such as AADC, or other meetings as assigned
• Position may require before or after hours work and/or may require weekend work

• American Association of Dental Consultants (AADC) Certification or Dental Coding or Reimbursement Certification (e.g. Dental Coding Consultant or Dental Benefit Specialist)
• Certification in health or dental benefits administration, such as Certified Employee Benefit Specialist (CEBS), Health Insurance Associate (HIA)