Project Manager

Mission

To level the playing field between dental practices and insurance companies nationally while building lifelong relationships with clients and teammates based on mutual trust, respect, and exceptional performance.

Our Mission

Dental practices participating with insurance groups find their margins shrinking every year. Our mission is to help dental practices navigate through the complexities caused by TPAs, gain a competitive advantage through strategic planning, optimize each provider's network participation, and achieve flawless execution and training.

Our Prime Directives

Recruit and hire extraordinary individuals who are motivated to become part of a team (family) and will embrace a culture of trust, confidence, respect, and accountability.

Attract responsive, respectful, and receptive clients (the 3 R's) who trust and value the knowledge and results PPO Negotiation Solutions offers, leading to referrals from like-minded dentists.

Provide the tools, training, and support from a leadership team that respects and offers continuous opportunities for professional and personal development.

Position Summary

The Project Manager oversees and manages the Insurance Optimization for dental insurance contracts on behalf of various private practices, MSOs, and DSOs. This position is involved in the development and implementation of contract management processes to achieve clients' contracting objectives and strategies. Additionally, this role provides leadership and training to assist in project management, customer service, and effective communication. The Project Manager will advocate for clients by informing them of available opportunities, outlining the pros and cons of each plan, and guiding them to make informed decisions rather than allowing the client to dictate the course of action.

Core Functions

Negotiate and manage multiple complex payer fees with insurance companies on behalf of PPO Negotiation Solutions (PNS).

Work independently to draft, review, and revise "Final Strategies," "Mapping," and "Network Participation" charts, ensuring compliance with company policies, guidelines, and legal and regulatory requirements.

Collaborate with internal and external clients to resolve contract issues and prepare contract documents for approval and execution.

Develop relationships by collaborating with internal departments to successfully meet departmental and strategic goals.

Understand contract reimbursement methodologies for PPO groups.

Collaborate with the senior analytics team to prepare, analyze, review, and project the financial impact of larger or more complex payer contracts and alternate contract terms, ensuring accurate reimbursement terms are reflected in all contracts.

Manage contracts for joint ventures, acquisitions, and new facility openings.

Actively participate in, lead, and / or complete special projects, develop and implement tools for process improvements, and serve as a resource for contract interpretation.

Serve as a resource to assist clients and their support teams in interpreting claim reimbursement language and resolving reimbursement issues by reviewing and interpreting EOBs.

Assist in resolving elevated and complex payer concerns by collaborating with the PNS team.

Provide training to dental practice support teams on effective "verification of benefit" calls, reviewing EOBs, ensuring claims were processed correctly under the designated payer and correct negotiated fees, and troubleshooting improperly processed claims by PPO Insurance groups.

Work cross-functionally with other PPO Project Managers across the company to orchestrate, execute, and deliver the best strategies to increase clients' claim reimbursements.

Metrics

• Quality Assurance :

Achieve a minimum average QC call score of 55 or greater out of a possible 60.

Secure a minimum of 2 Google reviews per quarter.

Achieve a minimum monthly "Active" sales target of $17,000 by effectively initiating and completing projects, collaborating with the Intake Specialist for project assignments, and minimizing project derailments.

Achieve and maintain a high level of team satisfaction by fostering a positive work environment, effective communication, and strong leadership.

Duties / Responsibilities

Credentialing & Contract Management

Responsible for credentialing all providers listed in the scope of the project.

Responsible for credentialing facilities listed in the scope of the project with insurance carriers.

Responsible for negotiating in-network contracts with insurance carriers for providers.

Coordinate the accurate input of provider information into CAQH, Medicare, and Medicaid databases when project details require it.

Complete Standardized Credentialing Application & Termination forms in MS Word files for each provider.

Ensure provider information is forwarded to the appropriate channels during the credentialing and negotiation phases.

Maintain provider files for credentialing purposes and ensure documents are current.

Client Support & Advocacy

Communicate with providers to gather, review, and provide guidance on completing credentialing packets.

Provide direction to clients on contract renewals related to the "Final Strategy" of the project.

Notify appropriate organization members of any changes or obstacles during the project, such as the addition of a new provider, the sale of the practice, or policy changes in a PPO's provider pickup under an umbrella plan.

Update the appropriate departments on the status of the provider's credentialing process.

Assist in resolving elevated and complex payer concerns by collaborating with the PNS team.

Advocate for clients by presenting available opportunities, explaining the pros and cons of each option, and guiding clients to make informed decisions that align with their strategic goals.

Project Coordination & Documentation

Utilize PNS's proforma spreadsheet to identify clients' current network participation and project potential revenue gains.

Effectively use Asana project management software to monitor and track project progress, adjusting as needed when unexpected events occur.

Customize "Final Strategy," "Mapping," and "Network Participation Chart" templates based on project specifics and client instructions.

Oversee the input of provider documents into PNS's database and proper maintenance of private documentation.

Confirm the "in good standing" status of CVs, provider licenses, DEA, and specialty certificates.

Training & Team Collaboration

Provide training to Client's administrative teams on effective "verification of benefit" calls, reviewing EOBs, ensuring claims were processed correctly, and troubleshooting improperly processed claims.

Assist the team in creating and updating training materials.

Work effectively as a team member with other members of management, the SPS, and PPO teams.

Assist with the development of strategic plans.

Exemplify the desired culture and philosophies of the organization.

Minimum Qualifications

Demonstrated skills in problem analysis and resolution, contract management, oral and written communication.

Problem-solving skills and complex decision-making abilities.

Highly developed interpersonal and listening skills.

Detail-oriented with exceptional time management skills to keep projects on course and meet deadlines.

Ability to function independently with flexibility in multiple project management.

Negotiation experience is a plus.

Strong interpersonal skills to interact effectively and cultivate supportive relationships with internal customers, managed care payers, consultants, outside agencies, and internal / external corporate executives.

Ability to manage all contractual aspects of major projects.

Excellent written, proofreading, and verbal communication skills.

Strong computer skills and a minimum typing speed of 40 WPM.

Knowledge of Google products is a plus (Canned Emails, Google Sheets, Google Docs, etc.).

Acknowledgment and Agreement

I acknowledge receipt of the Project Manager Job Description. I was encouraged to ask questions before signing this acknowledgment.

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