Quality and Compliance Coordinator – Dental

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    "datePosted": "2026-06-03T04:00:00.000Z",
    "description": "<h2>Overview</h2>\n<p>The Quality Management Coordinator is an in-office position, responsible for assisting with the preparation of dental records (charts and x-rays), opening new grievances, and managing payer and dental board complaints. This position ensures all grievances and appeals are processed in a timely manner and that data is entered accurately. The QM Coordinator plays a key role in maintaining member satisfaction, regulatory compliance, and quality improvement initiatives.</p>\n<h2>Responsibilities</h2>\n<ul>\n <li>Receive, document, and acknowledge grievances and appeals within required timeframes.</li>\n <li>Investigate complaints involving dental benefits, claims processing, provider services, and quality-of-care concerns, including research and follow-up with dental offices.</li>\n <li>Prepare dental records, including patient and office history, dental ledgers, and clinical documentation.</li>\n <li>Collaborate with internal teams, including the Grievance Coordinator and Sr. Manager of QM, to ensure proper handoff and resolution of grievances.</li>\n <li>Respond professionally and accurately, using proper grammar, to entities submitting complaints.</li>\n <li>Track and monitor open cases to ensure compliance with regulatory deadlines, including state Department of Insurance, CMS, payer guidelines, and NCQA standards.</li>\n <li>Maintain detailed and accurate documentation in the grievance tracking system and prepare reports on trends and outcomes as requested.</li>\n <li>Identify systemic issues or trends and recommend process improvements to enhance member, provider, and payer experiences.</li>\n <li>Support audits, compliance reviews, and quality improvement initiatives as needed.</li>\n <li>Educate teammates and others on grievance and appeals procedures to promote consistency and prevent recurrence of issues.</li>\n <li>Perform additional duties as needed to support the department.</li>\n <li> </li>\n</ul>\n<h2>Skills and Competencies</h2>\n<ul>\n <li>Strong analytical and investigative skills with excellent attention to detail.</li>\n <li>Excellent written and verbal communication skills.</li>\n <li>Working knowledge of dental benefits administration, utilization review, and provider relations.</li>\n <li>Ability to manage multiple priorities and meet strict deadlines.</li>\n <li>Proficiency in Microsoft Office and Adobe Acrobat.</li>\n <li>Strong commitment to confidentiality, professionalism, and member advocacy</li>\n</ul>\n<h2>Qualifications</h2>\n<ul>\n <li>Minimum of 1 year of experience in grievances, appeals, claims, or customer service issue coordination, preferably within dental or health insurance.</li>\n <li>Familiarity with dental terminology, CDT codes, and dental claims processing preferred. </li>\n <li>Must be willing to relocate or live in California for an in office role.</li>\n</ul>",
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