Senior Payment Integrity Dental Analyst

SmartLight AnalyticsPLANO, TX

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Overview

Schedule

Full-time

Education

Medical Coding (CCA, CCS, CCS-P, CPC)

Career level

Senior-level

Benefits

Dental Insurance

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.
Professionally present and defend payment integrity conclusions, supported by claims data and clinical rationale.
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 AnalyticsSmartLight 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.

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FAQs About Senior Payment Integrity Dental Analyst Jobs at SmartLight Analytics

What is the work location for this position at SmartLight Analytics?

This job at SmartLight Analytics is located in PLANO, TX, according to the details provided by the employer. Some roles may also include multiple work locations depending on the requirement.

What pay range can candidates expect for this role at SmartLight Analytics?

Employer has not shared pay details for this role.

What employment applies to this position at SmartLight Analytics?

SmartLight Analytics lists this role as a Full-time position.

What experience level is required for this role at SmartLight Analytics?

SmartLight Analytics is looking for a candidate with "Senior-level" experience level.

What education level is required for this job?

The education requirement for this position is Medical Coding (CCA, CCS, CCS-P, CPC). Candidates with relevant qualifications or equivalent experience may also be considered.

What benefits are offered by SmartLight Analytics for this role?

SmartLight Analytics offers Dental Insurance for this position. Actual benefits may vary depending on the employer's policies and employment terms.

What is the process to apply for this position at SmartLight Analytics?

You can apply for this role at SmartLight Analytics either through Sonara's automated application system, which helps you submit applications 10X faster with minimal effort, or by applying manually using the direct link on the job page.