Network Providers Representative
Delta Dental of California - San Francisco, CA

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We have one remote Network Providers Representative opening to handle the TERRITORIES IN COLORADO, IOWA, MINNESOTA, NORTH DAKOTA, NEBRASKA, SOUTH DAKOTA and WISCONSIN area. We are looking for an analytical, motivated, detail-oriented, self-starter to be responsible for promoting the professional interests of Delta Dental and affiliated companies by developing a strong network of participating providers, recruiting and retaining independent network providers, monitoring provider compliance with Delta Quality Assurance Standards and facilitating the effective resolution of grievances from groups and/or enrollees. Duties to include: Recruiting providers, including interviewing prospective providers, analyzing acceptability according to standards, negotiating contracts and coordinating required credentialing documents. Managing and servicing network providers within assigned geographic territory, monitoring utilization patterns of providers, interpreting statistics and recommending practice management tools to facilitate effective plan administration. Conducting training and professional dental seminars for providers and staff. Maintaining effective communication with Marketing, Customer Relations and QM staff; assisting with employer group communication. Conducting Quality Management follow-up; coordinating grievance information, including contact with office and record retrieval and resolution follow-up. Analyzing network needs with assigned geographic territory and interpreting statistics. Reviewing and analyzing competitor information and internal data to determine network needs and to increase network; evaluating and determining cost effectiveness of contracting each particular provider. Performing miscellaneous duties as assigned including, but not limited to, assisting other departments.
Ideal candidate will have: A high school diploma or GED, a bachelor's degree is preferred. Three years dental office administration and/or clinical dental assisting/hygiene experience. One year managed care administration experience. Background in sales and/or customer service a plus! Valid driver's license and ability to maintain an acceptable Department of Motor Vehicle record and purchase and maintain $250,000/$500,000 collision damage liability insurance policy for the car which they will receive the auto allowance. The ability to obtain and maintain sufficient credit to manage related job expenses including, but not limited to, applying to and being approved by a third party charge card agency to receive the company's corporate charge card. Ability to travel, including overnight stays; airplane travel required; must possess a valid driver's license and be able to drive a motor vehicle. Detail oriented, flexible and creative. Strong organizational/time management skills and multi-tasking abilities. Analytical and problem-solving skills. Knowledge of Delta policies and procedures. Knowledge of Current Dental Terminology ('CDT') codes and dental nomenclature. Knowledge of Delta products is a plus! Strong negotiation skills. Must be able to understand fairly complex written and oral instructions. Ability to clearly present written information and findings. Ability to communicate concepts. Strong telephone skills. The ability to interact well with co-workers and outside contacts. PC literacy; MSOffice skills (Office, Word, Excel, PowerPoint, Outlook); working knowledge of Internet and Intranet. We offer a highly competitive salary and an excellent benefits package for employees and eligible dependents.To apply, email resume with reference #IRC38229CB to recruit@delta.org or go to http://www.deltadentalins.com and click on 'CAREERS' to apply online.In connection with your application for employment with Delta Dental of California and its related companies, please note that any offer of employment made to any applicant will be contingent upon the satisfactory results of a background check. Such background check may include, but is not limited to, an investigation of credit worthiness, a check of references, employment and education verification, a check of criminal records and/or any other investigations as permitted by law. EOE/AA

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