Network Management Rep II-MN-57899
WellPoint - Eagan, MN

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DeCare Dental is a proud member of the WellPoint family of companies and is one of the fastest growing dental benefit management companies in the United States. At DeCare Dental, we are dedicated to improving the lives of the people we serve and the health of our communities. Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine. The Network Management Representative II is responsible for coordinating recruitment and retention activities associated with assigned dental networks that support various customers and partners.
        Network recruitment and retention activities include provider contracting, dentist recruitment, prover grievance resolution and regular communications with dental offices or dentists on contractual and reimbursement issues. Essential duties may include, but are not limited to: Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction. Researches and resolves the more complex provider issues and appeals for prompt resolution . Coordinates prompt claims resolution through direct contact with providers and claims department. Provides assistance with policy interpretation. Researches, analyzes and recommends resolution of provider disputes as well as issues with billing and other practices. Assists providers with provider demographic changes as appropriate. Responds to provider issues related to billing, pricing, policy, systems and reimbursements. Determines if providers were paid according to contracted terms. Provides explanations based on terms of contractual agreement and organization's protocols, procedures, policies. Develops, maintains, and enhances relations with providers to foster cooperative business relationships. Collects data and compiles a variety of reports. Performs other duties as assigned. DeCare Dental is a proud member of the WellPoint family of companies and is one of the fastest growing dental benefit management companies in the United States. At DeCare Dental, we are dedicated to improving the lives of the people we serve and the health of our communities. Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine. The Network Management Representative II is responsible for coordinating recruitment and retention activities associated with assigned dental networks that support various customers and partners. Network recruitment and retention activities include provider contracting, dentist recruitment, prover grievance resolution and regular communications with dental offices or dentists on contractual and reimbursement issues. Essential duties may include, but are not limited to: Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction. Researches and resolves the more complex provider issues and appeals for prompt resolution . Coordinates prompt claims resolution through direct contact with providers and claims department. Provides assistance with policy interpretation. Researches, analyzes and recommends resolution of provider disputes as well as issues with billing and other practices. Assists providers with provider demographic changes as appropriate. Responds to provider issues related to billing, pricing, policy, systems and reimbursements. Determines if providers were paid according to contracted terms. Provides explanations based on terms of contractual agreement and organization's protocols, procedures, policies. Develops, maintains, and enhances relations with providers to foster cooperative business relationships. Collects data and compiles a variety of reports. Performs other duties as assigned.

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        We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more...