[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, incorporating a sound business plan strategy to support recruitment efforts.
• 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.
• Establish and maintain contact and rapport with dental staff members, office managers, insurance coordinators, hygienists and dentists throughout an assigned territory.
• Formally present and effectively communicate UCD's administrative and claim guidelines and policies.
• Interpret and articulate contractual language and address questions regarding participation with providers.
• Meet with all identified practices in assigned territory to review practice financial and quality performance.
• Perform effective on-site visits through educating providers on financial advantages and marketing incentives of participation.
• 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.
• Develop and maintain leasing revenue targets.
• Update network lease risk strategy in response to market changes.
• Communicate and maintain effective working relationships both internally and externally.
• Support competitive position in the marketplace by staying abreast of changes to the business climate.
• Monitor provider reimbursement methods and communicate changes to provider community and leadership team.
• 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 or professional experience in presenting concepts and influencing others (Required)
• 3-5 years of experience as Dental Office Manager or Dental Hygienist (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, determine points of relevance and proper course of actions

Travel Required

• 0% - 25%

Physical, Mental Demands and Working Conditions

• Position Type: Remote
• Teaches / trains others regularly: Does Not Apply
• Travel regularly from the office to various work sites: Occasionally
• Works primarily out-of-the office selling products/services: Never
• Physical work site required: No
• Lifting: up to 10 pounds: Constantly
• Lifting: 10 to 25 pounds: Occasionally
• Lifting: 25 to 50 pounds: Occasionally

Pay Range

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

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.