Manager Dental Government Business Operations

Company :

United Concordia Dental

Job Description : 

JOB SUMMARY

*** Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen and must also pass a background check. ***

This job is responsible for managing the contracts that support the dental government business, as well as the staff that support the contracts. Responsibilities include managing daily operational activities for enrollment and billing, claims, including foreign claims, and customer service telephone, written and appeals. Employees are cross-trained to support multiple contracts. Position serves as a government point of contact for enrollment and premium reconciliation, overseas provider network issues and support, and for operational issues and audits. Assists in the development of the budget for each contract.

ESSENTIAL RESPONSIBILITIES (Describes the critical tasks, duties and responsibilities of the position.)

• Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; oversees accuracy of internal and government reporting data, assists with budget development and tracks monthly expenses to ensure budget compliance.
• Provides management oversight of the day-to-day activities related to enrollment and monthly premium billing issuance and reconciliations with the government.
• Develops plans of action and provides manager support to utilize effectively workforce management tools and reports to ensure all timeliness and accuracy requirements are met for enrollment/billing, claims customer service telephone and written/appeals are met for all contracts (TDP, ADDP, and FHFA).
• Functions as a government point of contact for enrollment and premiums reconciliation, oversees provider network issues/support, for operational claims or customer service issues and for government audits. 
• Oversees the daily activity for foreign claims processing and customer service, which requires foreign translations of claims, narrative and other documents, and foreign current conversions for oversees provider payments.
• Oversees the training program to ensure that training course content is complete, current, and meets the initial and ongoing cross-training instruction needed to service multiple contracts with competency and accuracy.
• Functions as the department representative for meetings related to system changes that impact operations.
• Other duties as assigned or requested.

REQUIRED EDUCATION

High School Diploma/GED

Substitutions (Acceptable substitutions in lieu of a degree 1 ½ years’ experience  = 1 year college)

No Substitutions

PREFERRED EDUCATION

Bachelor’s Degree - Business, Healthcare or other related area.

EXPERIENCE

*** Due to Department of Defense (DOD) contract requirements, the incumbent who fills this position must be a US citizen and must also pass a background check. ***

Minimum: This section refers to the minimum years and type of applicable experience needed to perform the job.  Minimum requirements must be non-comparative, objective, and relevant.

• 3 - 5 years' experience functioning as a supervisory, or lead role responsible for assisting with employee development and/or oversight, preferably in a claims or customer service production environment
• Knowledge of government contract reporting and performance requirements, standards, policies and procedures
• Experience supervising or managing multiple processing functions, including enrollment and billing, claims/adjustments, and customer service telephone/IVR, and written/Internet correspondence (routine, priority and appeals)
• Experience in developing and executing effective policies, procedures and performance action plans to ensure that performance standards and corporate goals are consistently met
• Experience functioning as a lead and/or participant in the completion of projects

Preferred: This section refers to additional desired years and type of experience that the hiring manager would prefer, above and beyond the basic requirements of the job.

• Experience working in a production environment with diverse functions and multiple types of benefits and/or contracts
• Prior government business experience, preferably dental
• Knowledge of dental health policy applied to claims processing

KNOWLEDGE, SKILLS & ABILITIES (List the attributes required to perform the job through demonstrated service, education or training