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   Current UPMC employees must apply in HR Direct

Fraud, Waste, and Abuse Dental Auditor I, Remote

  • Job ID: 112697960
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Fraud, Waste & Abuse
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $28.33 to $47.73 / hour

Description

The Fraud, Waste and Abuse (FWA) Dental Auditor I is responsible for conducting dental audits and reviews regarding the analysis of dental care and services related to dental guidelines, dental coding, regulatory requirements, and resource utilization.  The FWA Dental Auditor I will be responsible for maintaining the FWA case system with accurate and detailed audit activities related to assigned audits. The FWA Dental Auditor I will routinely interact with members, providers, law enforcement and/or regulatory entities in the course of their duties. 

This position can be full time remote, if desired. 

In addition to assigned audits, the FWA Dental Auditor I responsibilities may also include:

Risk Assessments on FWA dental trends using fraud detection software and/or as assigned by Manager.

Performs prepayment review of dental claims for compliance with relevant dental billing and processing guidelines and to identify opportunities for fraud, waste and abuse prevention and control.

Review and conducts analysis of claims and dental records as related to dental audit.

Collaborates with internal Health Plan departments including Quality Improvement, Legal, and Medical Management to address matters of mutual concern.

Recommends possible interventions for loss control and risk avoidance based on the outcome of dental audits.

Acts as a dental resource for the FWA unit. 

Performs special projects as assigned by Management. 

Maintain or exceed designated quality and production goals.

 

Qualifications

  • Bachelor's degree in a related field (or equivalent years of experience) required.
  • Three (3) years of experience in health insurance required
  • Current and unrestricted dental hygienist or assistant licensure/certification strongly preferred
  • Two (2) years related clinical experience preferred; or any combination of education and experience, which would provide an equivalent background.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct