Dental Network Service Representative
Job ID: J170816
Company: United Concordia Dental
Location: Remote
Full/Part Time: Full time
Job Type: Day (United States of America)
AHN Facility:
Posted Date: December 17, 2020
JOB DESCRIPTION
Company :
United Concordia Companies Inc
Job Description :
JOB SUMMARY
This job services 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. Customize participating dental agreement forms for execution, analyze provider changes, facilitate provider file updates and draft confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.
- 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. Formally present and effectively communicate UCD's administrative and claim guidelines and policies, benefits of participation, fee schedules, plan designs, competitive position, product development, network options, strategic partnerships, utilization review, local/national client demographics and dentist distribution. Interpret and articulate contractual language and address questions regarding participation with providers, network share/leasing arrangements, opt in/out options, reimbursement methods, compensation models, including pay for performance and value added benefits. Meet with all identified practices in assigned territory to review practice financial and quality performance.
- 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. Collaborate with sales and customer service to respond to client/broker/member inquiries regarding provider contract, claim/member issues or provider file/record/directory discrepancies. Consult with dental director/dental advisers regarding clinical-related questions and policies, as well as, current dental terminology (CDT) changes, to resolve provider inquiries within a mutually agreed timeframe.
- 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.
- Other duties as assigned or requested.
EDUCATION
Required
- High School Diploma/GED
Preferred
- Bachelor's Degree – Business
EXPERIENCE
Required
- 3 – 5 years of experience in the healthcare/insurance industry or professional experience in presenting concepts and influencing others in varying audiences
Preferred
- 3-5 years of experience as Dental Office Manager or Dental Hygienist
LICENSES OR CERTIFICATIONS
Required
- None
Preferred
- None
SKILLS
- Written and oral communication skills
- Time management and organizational skills
- Knowledge of ADA/CDT codes and general dental terminology
- Negotiation skills
- Ability to analyze situations, determine points of relevance and proper course of actions
Language Requirement (other than English)
None
Travel Required
0% – 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Teaches / trains others regularly
Does Not Apply
Travel regularly from the office to various work sites or from site-to-site
Occasionally
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
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Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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BENEFITS
Total Rewards Program
In addition to competitive pay rates and flexible career growth, we show our employee appreciation through a comprehensive Total Rewards package, including:
- Medical and prescription drug, dental and vision coverages for your and your eligible dependents
- Health Saving and Flexible Spending Accounts
- Life, AD&D and disability insurance
- Employer-sponsored 401(k) plan
- Paid time off, including paid holidays
- Tuition reimbursement
- Volunteer opportunities
- Voluntary benefits
- Employee discounts
Wellness Resources and Programs
Employees have access to the following wellness programs and resources:
Employees have access to the following wellness programs and resources:
- Work-life resources, such as employee assistance programs and financial counseling services
- 24/7 telephone access to health and wellness coaching to achieve personal goals
- Onsite pharmacy services at major campuses
- Fitness center access for all employees inclusive of showers, lockers, and group exercise classes at major Highmark campuses, Allegheny General Hospital & West Penn Hospital
- Access to chronic condition management programs when enrolled in the employer-sponsored medical plan
- 100% coverage for preventive exams, including flu shots
- Incentive program that rewards employees
- Secure bicycle parking at major campuses
- Healthy food options at onsite cafeterias
- Employee networks to gather in the name of health
- Onsite seated massage and stress management classes including yoga, mindfulness and meditation
LIVING IN PITTSBURGH
Pittsburgh, PA is home to Highmark Health’s corporate headquarters, as well as the headquarters of many of our businesses and a majority of our career opportunities. When you live and work in Pittsburgh, you’ll experience a wide variety of lifestyle advantages. Take a look around and you’ll quickly see why Pittsburgh is one of America’s most liveable, most affordable, safest and happiest cities. Learn more about this exciting and inviting location:
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