Senior Payment Integrity Dental Analyst - Plano
10 hours ago
Job description
Position Overview:
The Senior Payment Integrity Dental Analyst serves as a primary liaison between the organization, carriers, TPAs, and clients for dental payment integrity matters.
This role is focused on carrier engagement, issue resolution, and professional representation of payment integrity findings, supported by a strong working knowledge of dental claims data and billing practices.
Responsibilities:
Act as a subject-matter expert on calls with carriers, TPAs, and clients to discuss dental payment integrity findings and resolution paths.
Review dental claims, billing patterns, and documentation to identify improper payments.
Interpret claims data and investigative findings and translate them into clear explanations for non-technical audiences.
Produce clear, defensible documentation suitable for carrier and TPA review.
Collaborate with internal teams to align findings prior to external discussions.
Qualifications:
- 5+ years of experience in dental payment integrity, dental claims analysis, or healthcare reimbursement.
- Direct experience engaging with carriers and TPAs, including leading or participating in calls.
- Strong understanding of dental billing workflows and CDT coding.
- Excellent written and verbal communication skills.
- Ability to interpret and explain claims data without performing advanced analytics.
Bonus points for:
Prior experience specifically focused on dental fraud, waste, and abuse or improper payment investigations.
Professional certifications such as:
Certified Dental Coder (CDC)
CPC, CCS, or similar coding certifications
AHFI or CFE
Experience working with commercial dental plans, TPAs, or self-funded employer plans.
Knowledge of local, state, and federal regulations related to health and dental insurance.
Experience in a dental provider or group practice environment.
How to be successful in this role:
Serve as a trusted, knowledgeable representative in carrier and TPA interactions.
Clearly explain payment integrity issues in a way that supports resolution, not conflict.
Balance strong dental knowledge with professional communication and relationship management.
Ensure findings are well-understood, well-documented, and defensible.
Who is SmartLight Analytics
SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare.
With this end in mind, SmartLight works for self-funded employers to reduce wasteful spending in their healthcare plan through our proprietary data analysis.
Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.Similar jobs
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