El Paso, TX Provider Partner Consultant, DentaQuest
Location: Candidate must be located in El Paso, TX.
Job Description:
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 onboarding of newly contracted providers. Administer on-site office reviews as required by network rules and regulations. This role does require travel up to 50% of the time.
How you will contribute:
- 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 networks.
- Help to maintain a secondary network.
What you will bring with you:
Required:
- Bachelor's Degree or relevant experience.
- 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.
Preferred:
- Dental knowledge with five (5) or more years of office experience.
- Managed Care Experience.
Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.
Life is brighter when you work at Sun Life:
- Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical, and financial.
- Retirement and Stock Purchase programs to help build and enhance your future financial security.
- A flexible work environment with a friendly, caring, collaborative, and inclusive culture.
- Great Place to Work Certified in Canada and the U.S.
- Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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