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Dental Director – Fraud and Waste
HumanaDental Director conducting clinical reviews of dental fraud and waste investigations. Overseeing claims preparation and coordination with law enforcement authorities in the United States.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in dental practice management, clinical review processes, and data analysis, with a strong focus on improving consumer experiences and ensuring compliance with industry standards. Proficient in conducting audits and investigations while effectively communicating findings and recommendations.
Highest-signal resume keywords
Doctor Of Dental Surgery (DDS) DegreeClinical Review ExperienceData Analysis SkillsStrong Written Communication SkillsManaged Care Industry Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical DentistryDental Claims ReviewAudit PreparationInvestigative ReportingBilling Practices Assessment
Soft Skills
Team LeadershipProcess ImprovementCommunication Skills
Tools & Technologies
MS Office (Word, Excel, PowerPoint, Visio, Project)
Certifications & Qualifications
Active Dental License
Industry Keywords
Dental Industry StandardsFraud InvestigationQuality ManagementUtilization ManagementMedicareMedicaidCommercial Products
About the role
Key responsibilities & impact- The Dental Director relies on dental background and reviews dental claims.
- Conduct clinical reviews associated with dental fraud, waste and abuse investigations and create recommendations.
- Stay up to date on all dental industry standards.
- Provide education and guidance for new data tools to review provider outliers.
- Coordinate investigations with law enforcement authorities and assemble evidence/documentation for successful adjudication.
- Conduct on-site audits of provider records ensuring appropriateness of billing practices.
- Prepare complex investigative and audit reports.
Requirements
What you’ll need- 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
- Solid understanding of process / workflow concepts
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
- Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
Benefits
Comp & perks- Benefits starting day 1 of employment
- Competitive 401k match
- Generous Paid Time Off accrual
- Tuition Reimbursement
- Parental Leave
- Work at Home Requirements