Provider Partner Consultant
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Job Description
Provider Partner Consultant strengthening Oklahoma dental provider networks for Sun Life’s DentaQuest. Educating offices, improving claims technology adoption, and expanding access to quality care.
Responsibilities:
- Analyze and monitor provider cost reports to educate providers and improve cost and quality performance
- Support dentists and dental office managers in understanding benefit programs, policies and procedures
- Educate providers through office visits, phone and email communication
- Promote technology solutions, web applications and electronic claims
- Negotiate special deals to maintain compliance and increase access in weak networks
- Recommend improvements to internal methods, procedures and Quality Assurance processes
- Facilitate oral health presentations for educational institutions and organizations
- Assist provider offices with electronic claims filing
- Answer remittance, payment, benefit, claims and eligibility questions
- Follow up on provider termination letters
- Represent clients and the company at trade shows, health fairs, audits and dental summits
- Maintain and submit required reports
- Resolve elevated complaints and issues for clients, members and providers
- Recruit providers and increase participation across applicable market lines of business
- Manage CAP office performance and recommend solutions to market issues
- Organize and present information to providers and staff
- Identify improvement opportunities, evaluate program feasibility and present recommendations
- Improve information exchange between the company and dental offices
- Resolve difficult claims issues with internal resources
- Strengthen and expand provider networks and maintain a secondary network
Requirements:
- Bachelor’s Degree in Business, Healthcare Administration or related field, or relevant work experience
- 3 years’ related work experience in a healthcare environment
- Strong presentation skills
- Excellent verbal and written communication skills
- Ability to work independently and as part of a team
- Knowledge of Microsoft Office
- Proven problem-solving skills
- Up to 50% local travel required
- Problem-solving and training experience
- Ability to make sound judgments based on available data with minimal supervision
- Dental knowledge with five or more years of office experience preferred
- Managed Care experience preferred
Benefits:
- Discretionary annual incentive award based on individual and business performance
- Generous vacation and sick time
- Paid family, parental and adoption leave
- Medical coverage
- Company-paid life and AD&D insurance
- Disability programs
- Partially paid sabbatical program
- 401(k) employer match
- Stock purchase options
- Employer-funded retirement account
- Flexible, inclusive and collaborative work environment
- Career growth support
- Reasonable accommodations for qualified individuals with disabilities or special disabled veterans
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