The Audit/Compliance Coordinator will be responsible for carrying out duties related to the ongoing administration of various Quality Management (QM)-related initiatives, programs, meetings and activities while coordinating various ongoing compliance activities as needed.
The Grievance Analyst I will be responsible for intake of all member, provider and Health Plan Partner grievances and appeals. In addition, the Grievance Analyst I will investigate and resolve certain member, provider and Health Plan Partner grievances and appeals.
The purpose of a business analyst is to act as the interception point between the business and technical team. As such, you will be responsible for understanding business processes and translating these into a set of requirements as well as working with the development team on functional designs for the solution.
As a business analyst with a passion for technologies, you will be a key part of the LIBERTY team, working closely alongside our team and developers to enable us to deliver services, critical to the success of a growing organization. You will need to understand the strengths and benefits of the Microsoft platform.
To be successful in the role, you'll need to understand how collaborative technologies can benefit business users, simplifying processes to achieve goals. You'll also be expected to be able educate business users.
Involved throughout the project lifecycle, a Business Analyst works with our team to understand as-is and to-be business process flows and requirements, as well as how information flows and changes through the business. The Business Analyst uses this information to assist in the design of the optimal IT solution and works closely with development and business users through implementation.
This position will be primarily responsible for representing LIBERTY Dental Plan to our health plan partner, and to be the “clinical presence” of LIBERTY in the Florida regional office, meeting with FL clients, responding to urgent requests for dental services, assisting the Internal Response Unit (IRU) with expedited case management issues as needed. Routinely, the Dental Director will perform adjudication of dental claims and prospective requests for dental services (referrals and pre-authorizations) in Florida along with other Dental Consultants. Additionally, this person will participate in other clinical review activities in Florida, such as participating in Florida Quality Management and Improvement activities such as clinical review of FL grievances, and meeting with FL clients for periodic joint operational meetings. The position will be full or part time (two to four days per week at inception) depending on volume and demand. The FL Dental Director also participates actively in Utilization Management and Review Programs. LIBERTY Dental Plan administers commercial, Medicare Advantage and Medicaid programs in Florida.
The Dental Director will report to the National Dental Director and will collaborate with other corporate Dental Directors to assist in the development of clinical guidelines and Qualify Management Improvement processes to ensure process improvement and consistency in all clinical activities across the enterprise, yet specializing in any unique FL requirements.
The FL Dental Director will be an active participant on the National Peer Review Committee in reviewing and analyzing Potential Quality Issues (PQIs), a member of Utilization Management Committee, Credentialing Committee and Quality Management & improvement Committee.