Liberty Dental Plan

Manager

• Lead and oversee all functions of the Grievance & Appeals department.
• Ensure appeals, grievances, and provider disputes are processed accurately and within required regulatory and contractual timeframes.
• Maintain compliance with applicable state and federal regulations and client-specific requirements.
• Monitor regulatory changes and integrate new requirements into organizational grievance and appeals processes.
• Identify operational issues, recommend solutions, and implement corrective actions to prevent recurrence.
• Evaluate existing workflows and develop procedures to support new and expanding health plan partnerships.
• Develop reports, analyses, and operational insights for internal committees, leadership teams, and key stakeholders.
• Provide administrative and operational support for Quality Management activities and committees.
• Assist with regulatory filings, including Evidence of Coverage (EOC) documents, benefit filings, service area expansions, and other plan-related submissions.
• Respond to regulatory inquiries, requests, and comment letters.
• Create audit materials, including universes and case file documentation, ensuring accuracy and completeness.
• Serve as the primary presenter and representative for Liberty Dental Plan during internal and external Grievance & Appeals audits.
• Foster positive, professional relationships with internal and external stakeholders.
• Perform additional duties as assigned.

Manager, Grievance & Appeals

Compliance

• Serve as the primary intake point for compliance requests, including audits, regulatory changes, corrective actions, and business-as-usual compliance activities.
• Lead and coordinate Quality and Customer Experience audits, regulatory reviews, and corrective action activities.
• Conduct triage and risk-based prioritization of incoming compliance work based on regulatory, contractual, financial, and operational impact.
• Research and resolve compliance issues related to CMS, state regulations, and contractual requirements.
• Prepare audit materials, evidence inventories, regulatory questionnaires, audit tools, and supporting documentation for regulatory and client reviews.
• Coordinate cross-functional efforts to ensure timely completion of compliance requests and audit responses.
• Support the development, tracking, and monitoring of Corrective Action Plans (CAPs) and remediation activities.
• Monitor regulatory and contractual changes and partner with stakeholders to implement required updates.
• Manage compliance workflows, assignment tracking, ownership determination, status monitoring, and closure validation.
• Analyze compliance trends, audit findings, and recurring control gaps to identify opportunities for process improvement.
• Assist with the development and standardization of compliance-related policies, procedures, reporting tools, and documentation.
• Collaborate with internal and external stakeholders to ensure compliance objectives and deadlines are achieved.
• Perform other duties and special projects as assigned.

Senior Quality Compliance Analyst

• Lead targeted recruitment efforts within assigned regions and execute retention strategies for General Dental Practitioners and Specialty Care Provider Networks to meet contractual obligations.
• Oversee provider network retention initiatives, ensuring long-term stability and engagement.
• Review and manage provider contract documents to ensure accuracy, completeness, and alignment with regional fee schedules.
• Evaluate fee increase requests from Network Managers and present proposed adjustments with justification to Executive Leadership.
• Research market trends and competitor compensation structures to develop and maintain competitive provider fee schedules.
• Implement internal controls and oversee the preparation of fee schedule addenda for assigned territories.
• Manage provider service initiatives, ensuring timely execution and adherence to deadlines.
• Establish and maintain strong provider relationships to promote network stability and trust.
• Collaborate with Provider Relations Operations staff to coordinate network recruitment outreach, including mailings, fax blasts, and notifications.
• Develop performance standards for staff, monitoring productivity to ensure goals are met.
• Hire and train new staff, including conducting interviews, scheduling training, and preparing instructional materials.
• Work with PR executive staff and Liberty's People Team to address employment matters, including performance-related disciplinary actions.
• Prepare and deliver internal and external reports, providing updates on recruitment and service projects to PR executive leadership.
• Work cross-functionally with Claims, Quality Management, Member Services, and other departments to resolve provider-related issues.
• Participate in Utilization Review Committees and other relevant committees as directed by executive leadership.
• Assist in developing and refining processes, policies, and procedures to improve network operations.
• Conduct weekly meetings with direct reports to assess progress and address challenges.
• Provide strategic insights and performance updates to the PR executive team.
• Perform other duties as assigned by executive leadership.

Manager, Network Management & Performance

General

• Review dental claims, referrals, and prior authorization requests across multiple lines of business.
• Apply clinical expertise to evaluate treatment plans, radiographs, chart notes, and supporting documentation.
• Make coverage determinations based on benefit plans, clinical guidelines, medical necessity criteria, and applicable policies.
• Meet established productivity, quality, and turnaround-time standards.
• Document clinical rationale clearly and accurately in accordance with regulatory and accreditation requirements.
• Participate in calibration sessions to promote consistency and accuracy in clinical decision-making.
• Complete inter-rater reliability assessments and support ongoing quality improvement efforts.
• Collaborate with leadership and peers to address complex clinical scenarios and interpretation questions.
• Incorporate audit findings and feedback to continuously enhance determination accuracy and documentation quality.
• Conduct peer-to-peer consultations with treating providers regarding clinical determinations and treatment alternatives.
• Participate in grievance, appeal, and secondary review activities.
• Consult with dental specialists and subject matter experts as needed to support informed clinical decision-making.
• Maintain expertise in Liberty Dental Plan benefit structures and applicable Medicaid programs.
• Support regulatory reporting and accreditation-related activities.
• Stay current with ADA CDT coding updates, evidence-based treatment guidelines, and state-specific requirements.
• Participate in required training programs, departmental meetings, and organizational initiatives.

Staff Dentist, Part-Time, Nevada License

Staff Dentist – Part-Time, New Jersey License

Program Manager

• Serve as a subject matter expert on regulatory and contractual requirements affecting Liberty Dental Plan’s business lines
• Monitor, track, and maintain a repository of regulatory requirements, summarizing key updates for leadership
• Collaborate with internal departments to implement new contract and regulatory requirements
• Research and advise on ad hoc compliance-related inquiries
• Respond to client and regulatory audits, including managing corrective action plans
• Review agreements, policies, and member-facing materials to ensure compliance with applicable requirements
• Oversee Liberty Dental Plan’s annual risk assessment, compliance workplan, and testing program
• Analyze compliance findings, identify trends, and provide performance improvement recommendations
• Develop and maintain compliance reporting tools, including dashboards and tracking summaries
• Lead compliance-related initiatives and special projects, supporting process improvements
• Ensure compliance training materials are updated and coordinate enterprise-wide training
• Support the HIPAA compliance program, including incident management
• Coordinate Compliance Committee meetings and prepare reports for the Board of Directors
• Identify opportunities to strengthen Liberty Dental Plan’s culture of compliance

Compliance Program Manager – Government-Managed Healthcare Regulations

Accountant

• Process and apply daily payments accurately and timely.
• Prepare and distribute monthly invoices.
• Manage collection activities and monitor aging receivables.
• Escalate delinquent accounts as appropriate.
• Perform premium reconciliations and account balancing activities.
• Respond to client inquiries regarding billing, eligibility, and account-related matters.
• Process payments received over the phone.
• Support financial audits by providing documentation and account analysis.
• Calculate monthly accounts receivable reserves and document reserve rationale.
• Perform other duties and special projects as assigned.

Accounts Receivable Accountant

Claims Specialist

• Process dental claims, pre-authorizations, and referrals accurately and within required turnaround times.
• Perform high-volume data entry while maintaining accuracy and efficiency.
• Review and determine benefits according to plan guidelines and processing requirements.
• Maintain knowledge of service level agreements (SLAs) and applicable state regulations.
• Meet or exceed established production and quality goals.
• Support a positive, collaborative team culture.
• Follow established procedures, policies, and safety protocols.
• Perform additional duties and special projects as assigned.

Claims Referral Specialist I

• Review and process claims documents
• Collaborate with team members to resolve claim issues
• Maintain accurate records and documentation
• Communicate with clients regarding claim status and updates

Claims Referral Specialist II

• Manage customer inquiries via phone and email
• Provide support for product-related questions
• Collaborate with internal teams to resolve issues

Claims Referral Specialist III

Recruitment

• Recruit and contract General Dentists and Specialists to support network growth goals.
• Conduct outbound outreach to provider offices and build relationships with prospective providers.
• Develop and manage a robust recruitment pipeline using provider rosters, broker referrals, member nominations, inbound leads, and market research.
• Educate providers on the benefits of joining the Liberty provider network and guide them through the contracting process.
• Collect, review, and follow up on contracting and credentialing documentation to ensure complete and accurate submissions.
• Research fee schedules, analyze market opportunities, and develop territory recruitment strategies.
• Maintain detailed records of provider interactions and recruitment activity within CRM and tracking systems.
• Prepare activity reports and monitor performance metrics to ensure quality, productivity, and network growth objectives are achieved.

Provider Network Recruiter – Health Plans, Managed Care

Full-stack Engineer

• Lead the design, development, and testing of enterprise-level software applications
• Define technical direction, architecture, and Azure-based solution design
• Architect and build microservices, REST APIs, and cloud-native applications
• Mentor and lead a team of software engineers, fostering collaboration and professional growth
• Conduct code reviews to maintain code quality and promote best practices
• Collaborate cross-functionally with QA, product, and design teams
• Design and implement secure applications across front-end, middle-tier, and database layers
• Develop and optimize integration approaches (APIs, polling, webhooks)
• Monitor production systems, perform performance tuning, load testing, and resilience testing
• Troubleshoot and resolve complex technical challenges
• Drive CI/CD, DevOps practices, and containerized deployments (Docker, Kubernetes/AKS)
• Participate in Agile ceremonies including sprint planning and retrospectives
• Communicate technical concepts effectively to both technical and non-technical stakeholders

Lead Software Engineer

• Assist in recruiting General Dentists and Specialists to support network growth and meet access standards.
• Analyze network needs and identify gaps requiring additional provider recruitment.
• Manage and service provider relationships within assigned territory.
• Conduct service calls and site visits to ensure provider satisfaction and address concerns.
• Collect, review, and process provider contract documents for accuracy and completeness.
• Ensure compliance with annual attestation requirements and internal policies.
• Partner with internal teams and provider offices to resolve provider and member issues.
• Educate providers on policies, procedures, and network requirements.

Associate Provider Network Manager

Operations

• Coordinate the client reporting process, partnering with internal teams to ensure accuracy, timeliness, and alignment with client expectations.
• Identify and help resolve discrepancies in reporting, escalating complex issues as needed.
• Act as a liaison between Client Services and internal departments to facilitate communication and follow-through.
• Assist with client-related deliverables, including fulfilling requests and supporting Account Executives and Sales Coordinators.
• Maintain accurate and organized client account documentation, including reporting schedules and trackers.
• Ensure consistency and accessibility of operational records.
• Proactively identify and resolve routine operational issues.
• Contribute to process improvements by streamlining workflows, enhancing communication, and increasing efficiency.
• Support the development and refinement of procedures and documentation.

Market Operations Coordinator

• Manage scheduling, document preparation, and logistical coordination for Market Operations deliverables.
• Provide ad hoc administrative support to managers and analysts.
• Route requests and coordinate follow-ups between Market Operations and internal departments.
• Prepare and format client-facing materials including meeting agendas, summaries, presentations, and reports.
• Maintain accurate and organized documentation for contracts, renewals, trackers, and templates.
• Monitor project timelines, deliverables, and issue tracking to support on-time completion.
• Track key milestones and provide reminders and follow-ups as needed.
• Identify gaps in administrative processes and recommend improvements.