Summary of Job
Support activities related to the administration, monitoring, and oversight of the Commercial EmblemHealth Dental PPO Provider Networks. Ensure the integrity of the TruProvider provider file, compose, support and facilitate Credentialing compliance and protocols, and provide guidance for member and dental provider resolutions and grievance and appeal cases. Process the dental provider applications and perform quality assurance reviews for provider operations. Support the recruiting effort for the EmblemHealth dental networks. Serve as interdepartmental liaison for project management; provide support to the department to ensure that projects and departmental objectives are achieved with a sense of urgency. Prepare for and represent EmblemHealth at trade shows.
Responsibilities
• Support activities related to the administration, monitoring, and oversight of all dental network activities; participate in the development and implementation of recruitment strategies for geo-access and sales support, contract and conduct PR visits weekly.
• Work closely with all departments to identify and resolve systemic issues to reinforce provider/member retention and growth goals.
• Collaborate to produce and verify data needed to efficiently pay dental claims and resolve service/clinical related member/provider issues.
• Support the recruiting effort for the dental networks by assisting with calls, mailing and office visits.
• Prepare materials, provide technical and other support, and represent EmblemHealth at trade shows to recruit more dental providers to expand the network.
• Perform activities related to the credentialing process; participate in due diligence activities to ensure a dental network of high quality and integrity. Perform Provider Operations Quality Assurance review.
• Support projects to support dental product reliability and up-to-date communication (i.e., web site, provider manuals, orientation materials, recruitment, contract initiatives).
• Develop and maintain departmental databases to support analytical reporting needs.
• Volunteer on behalf of EH/GHI on NADP various workgroups.
• Identify and participate in key Dental trade conferences.
• Support Internal audits from SOX & SAS teams.
• Support Sales, Dental Product, Customer Service, and Account Management requirements for commercial dental PPO products.
Qualifications
• Bachelor’s Degree
• 3 – 5+ years of relevant, professional work experience (Required)
• 2 – 3+ years of experience in a dental setting (Required)
• Knowledge of the health care industry and health care products (Required)
• Understanding of dental provider credentialing/contracting and dental claims systems (Required)
• Familiarity with dental provider community (Required)
• Knowledge of dental network models, laws, and regulations (Required)
• Strong communications skills (verbal, written, presentation, interpersonal) with all types/levels of audience (Required))
• Proficient with MS Office - Word, Excel, PowerPoint, Outlook, Teams, etc. (Required)