This role should act as the primary on site point person for providers
to improve their understanding of our benefit programs, policies and
procedures. Responsible for provider networks with regard to office
education, technology promotion, network recruitment (expansion and
strengthening utilization), and general on boarding of newly contracted
providers. Administer on-site office reviews as required by network
rules and regulations.
JOB DUTIES AND RESPONSIBILITIES:
- Maintain network participation by providing support to dentists and
dental office managers to improve their understanding 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.
- Recruit non participating providers to join our networks.
- 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 liaison 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 health fairs, audits, dental
summits, etc throughout your designated market.
- 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
levels of participation.
- 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.
- Other duties as assigned.
Required Skills
- Bachelors Degree or relevant experience - preferred
- Strong presentation skills.
- Excellent verbal and written communication skills.
- Ability to work independently and as part of a team.
- Knowledge of Microsoft Office.
- Proven problem-solving skills.
- Own transportation for office and site visits (10% - 50%
travel required). Valid driver’s license required.
- Problem solving and training experience.
- Ability to make good judgment conclusions based on data available
with minimal supervision.
Required Experience
- Dental knowledge with five (5) or more years of office
experience preferred.
- Managed Care experience.