Provider Relations Representative III - TX
DentaQuest 56 reviews - Beaumont, TX

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This role should act as the primary on site point person for providers to improve their understanding of our benefit programs, policies and procedures. Responsible for provider networks with regard to office education, technology promotion, network recruitment (expansion and strengthening utilization), and general on boarding of newly contracted providers. Administer on-site office reviews as required by network rules and regulations.

Maintain network participation by providing support to dentists and dental office managers to improve their understanding of all available benefit programs.

Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email.

Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.

Recruit non participating providers to join our networks.

Negotiate special deals to maintain compliance and increase access in weak networks.

Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.

Facilitate Oral Health presentations to various educational institutions and organizations.

Assist provider offices in filing their claims electronically.

Serve as a liaison with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary.

Follow up with all termination letters submitted.

Represent clients and company at health fairs, audits, dental summits, etc throughout your designated market.

Maintain and submit all required reports.

Assist in resolving elevated complaints and issues for clients, members and providers.

Obtain letters of recommendation from providers.

Develop complete understanding of the Office Reference Manuals.

Develop and continually improve personalized presentations of company benefit programs

Recruit participating and non-participating providers to higher levels of participation.

Provide recommended solutions to market related issues.

Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities.

Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate.

Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices.

Resolve difficult claims issues in a timely manner by working with the appropriate internal resources to research and resolve such issues.

Increase access for members by strengthening and expanding existing network.

Help to maintain a secondary network.

Required Skills

Required Experience

Bachelors Degree or relevant experience

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.

Own transportation for office and site visits (10% - 50% travel required). Valid driver’s license required.

Problem solving and training experience.

Ability to make good judgment conclusions based on data available with minimal supervision.

Dental knowledge with five (5) or more years of office experience.

Managed Care experience.

About this company
56 reviews