Dental Policy Manager

Overview

The Dental Policy Manager I (DPM) serves as the client-facing dental policy resource for assigned clients. This role supports the ongoing accuracy and maintenance of dental payment policy sets according to industry and periodic policy updates for assigned clients, and analyzes payer policy, clinical standards, reimbursement requirements, and regulatory considerations and recommends updates within established policy frameworks. This position is client-facing and requires commitment to superior client service.

Responsibilities

• Support the accuracy and maintenance of assigned client dental payment policy sets by reviewing change requests, identifying potential impacts, and recommending appropriate updates within established guidelines.

• Conduct periodic and industry-update analyses for assigned clients using established review processes. Evaluate content changes, identify potential policy impacts, and recommend appropriate updates. Clearly understand and articulate new dental policy rules in an existing Decision Point, present the policies for consideration to the Dental Director for presentation to the client.

• Assist in the preparation of payment policy documents for presentation to the client, as needed, coordinate review and approval with Dental Director, and participate in client policy meetings.

• As the client-facing representative, partner with Dental Clinical Leadership, Content Team, and Compliance to analyze clinical, licensure, utilization-review, and compliance considerations, identify issues requiring specialized review, and coordinate recommendations with appropriate subject-matter experts.

• Review and analyze client inquiries and change requests for clarity of intent, applying decisions for affected policies, maintaining information, and communicating effectively with the client.

• Independently resolve routine and moderately complex client policy inquiries within established parameters and escalate novel, high-risk, or precedent-setting matters. Provide standard policy guidance and recommend appropriate action based on established dental payment-policy standards.

• Analyze policy, claims, and reporting information from multiple sources; identify relevant trends or discrepancies; and communicate findings and recommendations to internal and external audiences.

• Evaluate and document client-specific policy requirements, sensitivities, and approved exceptions to support accurate and consistent policy administration.

• Coordinate assigned projects using established project-management practices, includingmonitoring timelines, identifying risks, and communicating status.

• Apply working knowledge of relevant dental policy, claims, inquiry, and reporting applications to evaluate information and support accurate recommendations.

• Perform day-to-day responsibilities independently within established policies and procedures,receiving general guidance on new or unusually complex assignments.

• Complete all responsibilities as outlined in the annual performance review and/or goal setting. Complete all special projects and other duties as assigned.

• Must be able to perform duties with or without reasonable accommodation.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.

Qualifications

• Bachelor’s Degree in relevant field or equivalent, such as a Dental Hygienist

• Minimum 2 years of experience in dental claims, dental payment policy, dental coding, utilization management/review, payer operations, dental benefits administration, or a closely related field.

• Demonstrated knowledge of CDT coding, dental terminology, dental claim forms and data, dental reimbursement concepts, and common dental benefit and claim-adjudication practices.

• Certified Dental Coder or another relevant coding, compliance, utilization-management, or project-management credential.

• Knowledge of claims management billing systems is preferred.

• 2+ years’ experience in customer service or client management with a strong focus on healthcare setting.

• Knowledge of dental claims payment policy, processing, and reimbursement methodologies.

• Prior experience in developing dental payment policy edits preferred.

• Strong research capabilities and knowledge of ADA and CDT guidelines and other regulatory compliance guidelines and mandates, and dental payment policies.

• Knowledge of dental terminology.

• Clearly understands and articulates dental policies.

• Effective analytical and problem-solving skills.

• Professional with ability to properly handle confidential information.

• A track record of successful outcomes working within a collaborative team environment or highly matrixed structure.

• Strong interpersonal skills and the ability to work with on-site and remote cross-functional product teams and customers.

• Computer and technology literate with proficiency in MS Office Suite: Excel, Word, PowerPoint and Outlook.

• Willingness/availability to travel up to 15% is required.

Cognitive / Mental Requirements:

• Communicating with others to effectively exchange information.

• Assessing the accuracy, neatness and thoroughness of the work assigned.

• Ability to work with a high volume of transactions, effectively organize, prioritize and meet deadlines.

• Must be able to perform daily functions with a reasonable amount of direct supervision.

Physical Requirements and Working Conditions:

• This remote role can be located anywhere in the continental US.

• Remaining in a stationary position, often standing or sitting for prolonged periods.

• Repeating motions that may include the wrists, hands, and/or fingers.

• Must be able to perform duties with or without reasonable accommodation.

• Must be able to provide a dedicated, secure work area.

• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

• No adverse environmental conditions expected.

Base compensation ranges from $78,000 to $106,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 11/9/2026Applications are assessed on a rolling basis. We anticipate that the application window will close on 1/9/2027, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.#LI-JB1#LI-Remote#senior