Provider Engagement Professional - Network Development and Relations - Dental
Full Time
Louisville, KY 40202
Posted
Job description
The Provider Engagement Professional 1 develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Professional 1 work assignments are often straightforward and of moderate complexity.
Responsibilities
The Provider Engagement Professional 1 - Network Development and Relations-Dental works directly with our Provider Network to develop and strengthen relationships. Educating our providers on the value of participating in the Humana Dental Network and creating a mutual professional relationship with those providers, is key to the growth of the Network. The ability to create an “easy to do business with” environment for the providers is a key function of this role.
- Work with DSO & large group partners on credentialing and re-credentialing projects.
- Work with claims unit to identify and assist in claim resolutions for providers on all systems
- Educate Provider Offices on all existing and new products and plans
- Provide support to Provider Offices on all maintenance and service issues
- Assist with member/provider disputes and provide assistance to SIU and G&A
- Assist Provider Offices/Rental Partners with any contract issue.
- Work proactively with offices regarding fee schedule and financial incentive discussions.
- Work with Rental Partners to assure cost saving measures have been met.
- Add/Term locations, associates and products to existing provider relationships
- Provide support with new product roll-outs and assist in re-contracting efforts
- Process terminations of providers
Required Qualifications
- 2+ years of experience with Dental platforms
- Must be Detailed oriented
- Proactive thought leadership/Root Cause problem resolution skills
- Excellent oral and written communication skills
- Ability to multi-task, manage multiple projects, and meet deadlines
- Desire to learn and advance
- 2+ years experience with Excel and Outlook
- Customer Care/Service Experience
Preferred Qualifications
- Bachelors Degree
- 3-4 years experience in Health Care industry
- Experience working with MTV, CBIS, QicLink, DPNMS
Scheduled Weekly Hours
40Not Specified
0
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