Willamette Dental Group

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Member Services
OR-Hillsboro
The Member Services Contract Compliance Coordinator acts as a subject matter expert for the organization in the area of contract compliance relating to grievances, notice of action or adverse benefit determinations, appeals, hearings, enrollee rights and care coordination. This position has specialized, in depth knowledge of contractual and compliance regulations such as; but not limited to, Oregon Administrative Rules (OARs) and regulations relating Centers for Medicare and Medicaid Services (CMS).•Oversees all contracts related to plan administration in the space of Member Services Department and ensures minimal risk of contractual non-compliance.•Acts as a liaison between the company plan partners and Coordinated Care Organizations (CCO).•Participates in plan initiated compliance activities.•Performs audits to ensure grievances, notice of action or adverse benefit determinations, appeals, hearings, enrollee rights and care coordination are completed within contractual requirements.•Ensures training documents and tools are updated and available for staff to reference as needed.The coordinator must be self-directed to:•Detect deficient controls and non-compliance with laws, regulations, policies, related to Member Services and contractually obligated assignments•Creatively develop monitoring tools and auditing processes•Coordinate all internal compliance monitoring and audits in Member Services according to requirement and perform incident investigations for same•Prepare issue reports summarizing audit and/or monitoring performed in Member Services, include findings, and recommended course of action to improve/resolve deficiencies in areas of non-compliance •Consult with and provide supporting documentation to department manager all compliance issues•Coordinate with department manager to design all corrective plans and implement•Analyze all changes recommended and identify further process improvement in order to achieve consistent compliance •Review grievance content for clarity the remaining books of business, preform editing for publication purposes and provide feedback to Member Services Representatives as well as the Member Services Quality Assurance Coordinator•Prepare quarterly grievance, NOA, appeal and hearing reporting for all CCO’s•Prepare numerous currently designed contractually obligated reports•Create internal processes for outreach programs assigned to Member Services•Coordinate outreach programs utilizing Member Services staff and monitor for compliance•Provide Dental Navigation relating to cases that require coordination between the provider groups and plans or CCO’s •Serve as a liaison between Member Services and:oInternal Marketing Department oDental office(s) or administrative department(s)oGovernment Relations on CCO related issues and decisions•Roles and responsibilities will also include: Training and oversight relating to the distribution of Notice of Actions (NOA) and Adverse Benefit Determinations as well as appeals and hearings Staff Development:•Explains compliance requirements and audit expectations to existing staff and new hires •Initiates and creates training modules for new hire and continuing education trainingoProvides maintenance of training modules, curriculum, and training timeline•Provides regular compliance monitoring and audits oParticipates in the creation of a standardized auditing tool to evaluate:Comprehensiveness of factsEfficient and appropriate handling items specified in the contractTimeliness of processing oMaintains records regarding audit outcomes and trends Reports training opportunities and opportunities for development to Department ManagerProvides trend data to Department Manager •On a Monthly basis prepares and analyzes Group and Individual Performance reports for management staff review.oMaintains trending statistics for each RepresentativeoMaintains trending statistics for Group
Pos. Type
Full Time Regular
Schedule
5 8-Hour Days
Job Req #
8112-1117:
Information Technology
OR-Hillsboro
The Data Architect will be responsible for the quality and governance of our data and how it is stored as well as submitting reports to management that outline the changing data needs of the company and come up with related solutions. This position will define, design and develop relational and/or multi-dimensional databases for warehousing of data. •Develop database architectural strategies at the modeling, design and implementation stages to address business or industry requirements•Lead Data Governance initiative within Willamette Dental Group•Maintain the integrity and security of the data•Create data monitoring solutions to maintain quality, integrity and security of the data•Provide insight into the changing database storage and utilization requirements•Develop an archiving strategy and work with the DBA team to implement it•Determines database structural requirements by analyzing client operations, applications, and programming; reviewing objectives with clients; evaluating current systems;•Develops database solutions by designing proposed system; defining database physical structure and functional capabilities, security, back-up, and recovery specifications•Installs database systems by developing flowcharts; applying optimum access techniques; coordinating installation actions; documents actions•Maintains database performance by identifying and resolving production and application development problems; calculating optimum values for parameters; evaluating, integrating, and installing new releases; completing maintenance; answering user questions•Prepares users by conducting training•Provides database support by coding utilities, responding to user questions, and resolving problems•Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations•Accomplishes information systems and organization mission by completing related results as needed
Pos. Type
Full Time Regular
Schedule
5 8-Hour Days
Job Req #
8102-1117:
Legal
OR-Hillsboro
This position is responsible for assisting Willamette Dental Group (WDG) in the management of the Quality Improvement Committee (QIC) and the development, implementation, operationalization and improvement of the “quality assurance and performance improvement” (QAPI) functions for the Company. These overlapping functions include addressing the quality improvement initiatives undertaken by the Company’s Quality Improvement Committee and the QAPI requirements of the Coordinated Care Organizations with WDG subcontracts within the Oregon Health Authority Medicaid program. This position helps to ensure that QIC initiatives and QAPI program results support theEssential Position Functions• Provide leadership in developing, implementing, operationalizing and sustaining short and long term plans, goals and objectives for the QIC and QAPI functions.• Ensure QIC and QAPI programs achieve desired outcomes and meet federal and state regulations, accreditation standards, quality metrics, client requirements, and the evolving requirement of the CCO models of care.• Cross functional and interdepartmental collaboration as it relates to: o Program identification, effected policies and unified outcomes o Identifying stakeholders in departments or job groups to train, communicate and develop internal processes and procedures that improve clinical quality o The goals of collecting data, program analysis and reporting program objectives to address QIC and QAPI initiatives• Provide ongoing data analysis to support oversight of ongoing initiatives.•Communicate issues or developments identified during quality improvement and quality assurance activities and provide recommendations for improvement.•Facilitate the development of action plans to address identified opportunities for improvement.•Develop and implement metrics to measure quality outcomes. Create processes and methods for data collection and reporting systems.• Lead QIC and QAPI team and facilitate activities in a timely manner.
Pos. Type
Full Time Regular
Schedule
5 8-Hour Days
Job Req #
8095-1117:
Patient Financial Services
Hillsboro
Provide superior customer service to internal and external customers through numerous communication channels. Cultivate collaborative and positive relationships with all entities within the organization. Assure appropriate handling of delinquent balances in support of company and department strategies, policies, and goals. Process patient insurance claims, payments, and inquiries.• Provide superior customer service to customers in response to high volume phone inquiries in accordance with established performance standards in a call center environment.• Partner with locations to arrange patient payment plans.• Accurately handle patient insurance billing by complying with standard operating procedures. This includes coordination of benefits, familiarity with preferred provider organization adjustments and filed fee adjustments.• Review orthodontic accounts monthly. Take appropriate action when loss or change of coverage occurs.• Manage multiple location’s accounts receivable. Audit accounts monthly for balances and credits utilizing excel reports.• Refer delinquent accounts to collection agency after exhausting all avenues of recovery including soft collection calls and correspondence.• Process location and department adjustments promptly.• Process credit balances and if appropriate refund to patient and/or insurance company.• Process accident billing for auto and on the job injuries.• Apply managed care contracted benefits according to eligibility.• Initiate telephone calls to insurance companies, employers and other outside sources to confirm eligibility, investigate claim processing/denials and resolve other concerns.• Maintain regular communication with management regarding workload, deadlines and staff concerns. Make recommendations to ensure the highest level of efficiency is being met.• Authorize credit card payments on patient accounts.• Develop and submit ongoing reports as requested which includes statistics, charts and graphs that utilize multiple computer programs and business math skills.
Pos. Type
Full Time Regular
Schedule
5 8-Hour Days
Job Req #
8094-1117:
Patient Financial Services
Hillsboro
•Plan, organize and direct department activities, developing department goals, standards and metrics ensuring a positive patient experience.•Review performance of the department functions on an ongoing basis and make changes as necessary to improve service and ensure compliance to regulatory requirements.•Establish, monitor and audit production and quality statistics to assure billing accuracy, timeliness and compliance to professional billing standards.•Manage the department budget, continually evaluating expenses and justifying any variances as needed.•Provide staff with the training, mentoring and resources necessary to carry out their work in an effective manner.•Ensure performance goals, expectations and standards are clearly understood by supervised staff and evaluate employees’ performance on an ongoing basis, taking corrective actions if needed.
Pos. Type
Full Time Regular
Schedule
5 8-Hour Days
Job Req #
8033-1017:
Learning & Development
OR-Hillsboro
The Orientation & Training Specialist will partner with stakeholders to develop and maintain the new employee program as well as other training initiatives to meet the needs of both the employees and the business. This position will design and develop content to support new employee orientation objectives for operations, facilitate new hire axiUm training, and provide training support for corporate and/or regional training projects. Essential Position Functions •Partner with Senior Orientation & Training Specialist to assess company-wide new employee program needs. •Partner with CSS team, directors and other stakeholders to provide and gather input on training projects and NEO program improvements. •Partner with subject matter experts (SMEs) to develop company training materials.•Facilitate corporate and/or regional training events.•Partner with SMEs to develop Pre-NEO, NEO and Post-NEO learning materials for all job groups. •Design job aids, self-guided axiUm modules, binder materials/resources, workbooks, self-assessments, rubrics, presentations, etc. as needed.•Partner with Development Specialists and other stakeholders to design overlapping Post-NEO onboard programs.•Manage classroom environment, analyze results and identify gaps in training needs.Knowledge, Skills, and AbilitiesKnowledge of:•Adult learning concepts and learning methodologies including instructional technology.•Needs analysis, instructional/program design, development and evaluation.•Project management processes •Microsoft Office, including Outlook, Word, PowerPoint and Excel and how to integrate technology into corporate professional development programs. Skilled in: •Facilitating training, both small and large groups.•Strong interpersonal skills, demonstrated ability to establish rapport and maintain successful relationships with all levels within an organization.•Exceptional written and verbal communication skills. Ability to: •Consult with and guide customers to solutions.•Work with ambiguity and constant change.•Accurately assess employee skill levels and be able to effectively give and receive constructive feedback. •Analyze information, prepare best scenario solutions and present in a professional manner.•Prioritize workload and shift gears as priorities change.•Travel to off-site meetings including periodic overnight stays. •Uphold and exemplify the company’s core values.
Pos. Type
Full Time Regular
Schedule
5 8-Hour Days
Job Req #
7988-0917:
Member Services
OR-Hillsboro
A key customer service position to ensure patient satisfaction. Provide Response to and support of patient concerns.Respond to patient inquiries and concerns and investigate possible resolutions, will work with computer data base and our dental office teams to resolve issues or provide information to our patients. Communicate effectively by correspondence, email, and phone with dental professionals, operational staff, and customers. Coordinate factual record of all contested or disputed grievances, process sensitive and confidential information with utmost judgment and tact, organize and assemble legal documents, manage multiple concurrent issues and high volume inquiries.Outstanding customer service and problem solving skills. Exceptional verbal & written communication capability. exceptional organizational skills, ability to prioritize tasks, ability to read and interpret documents such as contracted benefits, ability to work independently or as a team, and knowledge of Microsoft Word, Excel, and Adobe Acrobat software tools. Candidates with a medical or dental background will be given immediate consideration. Willamette Dental Group is a 2014 Press Ganey Success Story Award Winner in Recognition of our Innovative Approach to Organizational Change in Patient Experience
Pos. Type
Full Time Regular
Schedule
5 8-Hour Days
Job Req #
7971-0817:
Talent Acquisition
OR-Hillsboro
Responsible for managing the full cycle recruiting process from requisition approval through successful selection. Partner with hiring managers to provide quality candidates in a timely and efficient manner. Ensure processes and tools are designed to meet the business needs in a cost-effective and high quality manner and that the best talent is hired for Willamette Dental Group. May provide guidance and knowledge to team members on hiring best practices, up-to-date recruitment and selection techniques, processes and legal compliance. Track and evaluate effectiveness of recruitment and selection process and performance success of hired employees. -Work closely with hiring managers to define staffing needs, skills, knowledge and abilities necessary for each open position. -Educate and provide guidance on selection methods and processes. -Lead and manage entire selection process including, but not limited to, posting, sourcing, screening, interviewing, assessment testing, reference & background checking, and providing sound recommendations to hiring managers to ensure quality selection -Create and sustain effective methods and processes to identify, source, and hire the most qualified candidates for high volume positions. -Maintain and develop relationships with colleges/universities to maximize recruiting efforts; attend career fairs and coordinate open house events for recruiting and Company recognition. Lead College/University recruitment program for externships including job fairs and speaking engagements.-Utilize behavioral-based interviewing techniques and actively seek out and recommend new selection methods and tools to identify quality candidates for the organization. -Recommend and implement best practices, up-to-date recruitment and selection techniques, processes and legal compliance. Seek out new ways to increase the sourcing pool of specific job groups to attract quality candidates. -Stay current on knowledge of various recruiting techniques and practices through professional journals, seminars and networking events. -Provide guidance to hiring managers in determining starting compensation using Company guidelines; extend job offers; ensure appropriate correspondence and on-boarding paperwork is completed. -Guide hiring managers regarding hiring practices and procedures and ensure compliance and understanding of EEO, discrimination, wage & hour, ADA, and hiring guidelines.-Maintain all candidates information within Company’s Applicant Tracking System and ensure information is accurate, up-to-date, and notes are entered for each candidate interview. Responsible for training new users, responding to questions and running reports. -Keep current on new ATS features and upgrades and communicate with recruiting team and provide recommendations for increase efficiency and enhancements.-Special projects and additional tasks/administrative duties as assigned by management.
Pos. Type
Full Time Regular
Schedule
5 8-Hour Days
Job Req #
7917-0817:

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