Dental Director - Fraud and Waste

Humana Inc.

Job Overview

Location

Remote Nationwide

Job Type

Full-time

Full Job Description

📋 Description

• The Dental Director relies on dental background and reviews dental claims.
• The Dental Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
• The Dental Director provides dental interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards.
• Begins to influence department’s strategy.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.
• Exercises considerable latitude in determining objectives and approaches to assignments.
• Complete all clinical reviews associated with dental fraud, waste and abuse investigations and create a recommendation on the case direction.
• Stay up to date on all dental industry standards and provide education and guidance to creating new data tools to review provider outliers.
• Coordinates investigation with law enforcement authorities as well as assembles evidence and documentation to support successful adjudication, where appropriate.
• Conducts on-site audits of provider records ensuring appropriateness of billing practices.
• Prepares complex investigative and audit reports and advises executives to develop functional strategies for dental fraud, waste and abuse case on matters of significance.

🎯 Requirements

• Doctor of Dental Surgery (DDS) degree or DMD
• A minimum of five years of experience in a clinical dentist office as a practicing dentist
• Must hold a clear and active license to practice dentistry (in any US state)
• Must be comfortable with data analysis/report interpretation
• Strong computer skills including MS Office desktop applications (Word, Excel, PowerPoint, Visio, Project)
• Demonstrated competency in written communication skills

🏖️ Benefits

• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parental Leave

Skills & Technologies

Vue.js

Remote

$203k-279k

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Humana Inc.

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About Humana Inc.

Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.

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