Manager Dental Benefits and Third-Party Payer Issues at American Dental Association

Who We Are: It all starts with purpose.We are a purpose-driven nonprofit with a dynamic staff culture.With a meaningful purpose motivated staff and excellent benefits working here will definitely have you smiling! The ADAs headquarters is located just steps from Chicagos Magnificent Mile and close to public transportation. With more than 400 colleagues the ADA Staff are some of the most talented people in the Chicago Washington D.C. and Maryland area.We were named a Top Workplace by the Chicago Tribune in 2019 and 2021!Come join our team!Job Responsibilities:The Manager of Dental Benefits and Third-Party Payer Issues provides operational leadership for the ADAs Council on Dental Benefit Programs. The role oversees all aspects of the Associations 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.Must Have:Bachelors degree or experience in lieu of degree5 years of experience (or 9 years in lieu of a degree) program management or operations in the healthcare managed care or insurance industry including four years of experience in the dental industryExperience engaging with external organizations or payers to resolve issuesExperience with direct experience in dental benefits administration or managementComprehensive understanding of dental benefit plan design administration and reimbursement methodologiesKnowledge of claim adjudication processes coordination of benefits downcoding bundling and non-covered services policiesFamiliarity with provider network contracting fee schedules utilization management and prior authorization practicesMust have verbal communication writing analytical facilitation collaboration presentation a self-starter results-focused skillsProficiency 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 assignedPosition may require before or after hours work and/or may require weekend workNice to Have: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)Just a few of the benefits offered to employees:Promotes Work/Life BalanceHybrid Work Schedule (2-3 days from home)Health insurance/ dental reimbursement planAmple Paid time off401(k)PensionFlexible Spending AccountLife insuranceTuition reimbursementPaid Parental LeavePet InsuranceStudent Loan Refinance2 days off to work at a charity event of your choiceThe ADA values a variety of backgrounds and experiences and is committed to providing equal employment opportunities to qualified job candidates. The ADA is an equal opportunity employer of protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment in open positions without regard to race ethnicity gender color religion sex age marital status ancestry citizenship physical or mental disability medical condition veteran status or any other characteristic.The American Dental Association is committed to providing reasonable accommodations for candidates with disabilities in our recruiting process. If you need any assistance or accommodations due to a disability please let us know at Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.Required Experience:Manager Key Skills Vendor Management,Fmla,HIPAA,Analysis Skills,Benefits Administration,HRIS,Filing,Payroll,Employment & Labor Law,ADP,Human Resources,Workday Employment Type : Full-Time Experience: years Vacancy: 1