Provider Partner

Role Overview

• Analyze and monitor provider cost reports on an ongoing basis to educate and improve providers’ cost and quality performance
• Maintain network participation by providing aid to dentists and dental office managers to improve their awareness of all available benefit programs
• Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email
• Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims
• Negotiate special deals to maintain compliance and increase access in weak networks
• Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process
• Facilitate Oral Health presentations to various educational institutions and organizations
• Assist provider offices in filing their claims electronically
• Serve as a partner with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary
• Follow up with all termination letters submitted
• Represent clients and company at trade shows, health fairs, audits, dental summits, etc.
• Maintain and submit all required reports
• Assist in resolving elevated complaints and issues for clients, members and providers
• Obtain letters of recommendation from providers
• Develop complete understanding of the Office Reference Manuals
• Develop and continually improve personalized presentations of company benefit programs
• Recruit participating and non-participating providers to higher level of participation for all applicable market LOBs
• Manage CAP office performance
• Provide recommended solutions to market related issues
• Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities
• Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate
• Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices
• Resolve difficult claims issues in a timely manner by working with the appropriate internal resources to research and resolve such issues
• Increase access for members by strengthening and expanding existing network
• Help to maintain a secondary network

Requirements

• Bachelor’s Degree in Business, Healthcare Administration or related field (or relevant work experience)
• 3 years’ related work experience in healthcare environment
• Dental knowledge with five (5) or more years of office experience, preferred
• Strong presentation skills
• Excellent verbal and written communication skills
• Ability to work alone and as part of a team
• Knowledge of Microsoft Office
• Proven problem-solving skills
• Up to 50% local travel required
• Problem solving and training experience
• Ability to make good judgment conclusions based on data available with minimal supervision

Benefits

• Health insurance
• 401(k) employer match
• Generous vacation and sick time
• Paid family, parental and adoption leave
• Medical coverage
• Company paid life and AD&D insurance
• Disability programs
• Partially paid sabbatical program