Illinois Provider Partner Consultant, DentaQuest
Illinois Provider Partner Consultant, DentaQuest
Location: Candidates must be located in the state of Illinois.
Job Description:
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.
How you will contribute:
- Maintain visibility within their market, with an eye toward managing their network across all product lines.
- Analyze and monitor provider cost reports on an ongoing basis to educate and improve providers’ cost and quality performance.
- Actively support VBP (Value Based Pay) program.
- Responsible for recruiting new providers and maintaining network participation by providing support to dentists and dental office managers to improve their understanding of all available benefit programs.
- Responsible for educating providers, serving as the primary point of contact for instruction 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.
- 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.
- Represent clients and company at trade shows, health fairs, audits, dental summits, etc. throughout the designated market and/or state.
- Responsible for creation and submission of all required reports.
- Acts as a subject matter expert for their respective geographic area.
- Develop complete understanding of the Office Reference Manuals for implementation within their region.
- Develop and continually improve personalized presentations of company benefit programs.
- Provide recommended solutions to market related issues.
- Measure impact of provider satisfaction (as tied to annual objectives of the team) and respond to provider 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.
- Performs in-depth analysis of fee schedules, including fee schedule comparisons, to negotiate competitive custom fee schedules where needed.
- Provides regular updates to senior management on internal and external issues affecting network market performance.
- Develop and implement processes to improve overall client and provider satisfaction.
- Develop and maintain relationships with appropriate functional areas within DentaQuest to ensure effective contract performance.
- Support innovative business practices and process improvement opportunities for current and prospective clients (e.g., P4Q, QARR, ER Diversion).
- Maintain a secondary network to ensure access to care for all eligible members.
- Other duties as assigned.
What you will bring with you:
- Bachelor’s Degree in Business, Healthcare Administration or related field (or relevant work experience).
- 3 years’ related work experience in healthcare environment.
- 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.
- Problem solving and training experience.
- Ability to make good judgment conclusions based on data available with minimal supervision.
Preferred Qualifications:
- Dental knowledge with five (5) or more years of office experience.
- Managed Care experience.
PHYSICAL DEMANDS:
- 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.
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 – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more.
- Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account.
- 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.
- Illinois Range: $69,400.00 - $104,100.00 USD Annual.
We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.
Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter - for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
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