[Hiring] Provider Relations Liaison @Highmark Health

Role Description

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.
• Incorporate a sound business plan strategy to support recruitment efforts.
• Customize participating dental agreement forms for execution.
• Monitor financial performance of contracts by tracking utilization and competitive environment.
• Analyze and develop network retention strategies for follow-up services to providers.
• Formally present and effectively communicate UCD's administrative and claim guidelines.
• Interpret and articulate contractual language and address questions regarding participation.
• Perform effective on-site visits through educating providers on financial advantages.
• Train dental office staff on the use of automated services.
• Collaborate with sales and customer service to respond to client/broker/member inquiries.
• Consult with dental director/dental advisers regarding clinical-related questions and policies.
• Act as subject matter expert with recommendations and data supporting development of network and sales strategy.
• Communicate and maintain effective working relationships both internally and externally.
• Develop and manage process improvement initiatives designed to maintain URAC accreditation.
• Conduct, collect and analyze data from office site visits and reviews.
• Train dental office staff and providers on updates to quality assurance guidelines.
• Conduct audits as needed.
• Other duties as assigned or requested.

Qualifications

• High School Diploma/GED (Required)
• Bachelor's Degree - Business (Preferred)

Experience

• 3 - 5 years of experience in the healthcare/insurance industry (Required)
• 3-5 years of experience in Dental Operations, Revenue Cycle Management, Payer Relations (Preferred)

Licenses or Certifications

• None (Required)
• None (Preferred)

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 and determine proper course of actions

Travel Required

• 0% - 25%

Physical, Mental Demands and Working Conditions

• Position Type: Office-Based
• Travel regularly from the office to various work sites: Occasionally
• Physical work site required: Yes
• Lifting: up to 10 pounds: Constantly
• Lifting: 10 to 25 pounds: Occasionally
• Lifting: 25 to 50 pounds: Occasionally

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. Employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.

Pay Range

• Minimum: $58,100.00
• Maximum: $90,000.00

Equal Opportunity Statement

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 any category protected by applicable federal, state, or local law.

Accessibility Statement

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