Dental Network Service Representative

Dental Provider Relations

Job Summary : Looking for someone with Dental Provider Relations to service United Concordia Dental's (UCD's) clients by recruiting, training and servicing quality dental networks in assigned territory in a remote and mobile work environment. Manage network contracts including negotiations, contract development / renewal and financial reimbursement. Meet with dentists and office personnel to act as the intermediary between the organization and UCD. Respond to contractual and payment issues both internally and externally. Ensure compliance with contractual terms through regular on-site audits. Apply an active role in network management, training, monitoring and enforcement of company policies and procedures while increasing provider efficiencies.

Essential Responsibilities :

• Identify and initiate contact with prospective providers. Develop and follow up on leads in an established time frame, while incorporating a sound business plan strategy to support and execute recruitment efforts that include existing and prospective client needs and provider resignations / terminations.
• Analyze and develop network retention strategies for follow up services to providers by establishing and maintaining contact and rapport with dental staff members, office managers, insurance coordinators, hygienists and dentists throughout an assigned territory by scheduling face-to-face meetings with dental offices.
• Perform effective on-site visits through educating providers on the financial advantages and marketing incentives of participation. Train dental office staff on the use of automated services to ensure they utilize various means of automated communication, as well as, claims and electronic data interchange and electronic funds transfer.
• Act as subject matter expert with recommendations and data supporting development of network and sales strategy and support of leasing contract negotiation. Develop and maintain leasing revenue targets. Update network lease risk strategy in response to all market changes.
• Communicate and maintain effective working relationships both internally and externally (providers, dental industry, organized dentistry and dental consultants) keeping management informed on related healthcare industry issues / topics. Support competitive position in the marketplace by staying abreast of changes to the business climate. Monitor provider reimbursement methods and PPO / DHMO / EPO network models and communicate changes to provider community and leadership team.
• Develop and manage process improvement initiatives designed to maintain URAC accreditation of all network practices associated with government programs using continuous quality improvement principles. Conduct, collect and analyze data from office site visits and reviews to continually improve the care and service to members and provide recommendations to internal customer supporting quality improvement programs. Train dental office staff and providers on all updates to quality assurance guidelines, with state and local regulations and URAC accreditation requirements. Conduct audits as needed.

Education :

Experience :

Licenses or Certifications :

Skills :

Language Requirement (other than English) : None

Travel Required : 0% - 25%

Physical, Mental Demands and Working Conditions :

Pay Range Minimum : $50,200.00

Pay Range Maximum : $91,200.00