Dental Quality Management Coordinator

Job description

Overview The Grievance 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. Responsibilities: - Receive, document, and acknowledge grievances and appeals within required timeframes. - Investigate complaints involving dental benefits, claims processing, provider services, and quality-of-care concerns, including research and follow-up with dental offices. - Prepare dental records, including patient and office history, dental ledgers, and clinical documentation. - Collaborate with internal teams, including the Grievance Coordinator and Sr. Manager of QM, to ensure proper handoff and resolution of grievances. - Respond professionally and accurately, using proper grammar, to entities submitting complaints. - Track and monitor open cases to ensure compliance with regulatory deadlines, including state...