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The Provider Partner is the primary on site point person for providers to improve their understanding of our benefit programs, policies and procedures. The Provider Partner is responsible for provider networks with regard to office education, technology promotion, network recruitment (expansion and strengthening utilization), and onboarding of newly contracted providers. The Provider Partner is also responsible for administering on-site office reviews as required by network rules and regulations.
PRIMARY JOB RESPONSIBILITIES:
- Analyze and monitor provider cost reports on an ongoing basis in order to educate and improve providers’ cost and quality performance.
- 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.
- 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 trade shows, health fairs, audits, dental summits, etc. throughout the 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 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.
- Other duties as assigned.
- 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.
- Up to 50% local travel required.
- Ability to make good judgment conclusions based on data available with minimal supervision
- Bachelor’s Degree in Business, Healthcare Administration or related field (or relevant work experience)
- 3 years’ related work experience in healthcare environment
- Problem solving and training experience.
- Dental knowledge with five (5) or more years of office experience.
- Managed Care experience.
- Ability to work in a traditional professional office setting or remote equivalent.
- Ability to effectively operate computer equipment.
- Work schedule may vary and is determined by project schedules.
- Ability to travel as projects dictate
- Ability to efficiently operate all job-related office equipment.
- Ability to communicate via telephone and work in virtual teams
- The office environment is active with high voice levels and interruptions that may challenge hearing and concentration.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform this position.
** In accordance with DentaQuest’s Compliance Plan, employee must conduct DQ business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or DQ’s Compliance Officer. *
DentaQuest’s Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program.