(Archived) Provider Plan Relations Specialist 768

Purpose: By providing exemplary service and support, the Specialist contributes to the overall success of the Provider and Plan Relations Department by strengthening relationships with DentalOne Partners corporate departments, insurance payers, and affiliated dental practices and dentists, meeting department service level agreements and executing annual strategic plans. This position will support all comprehensive processes for credentialing and recredentialing, both new and existing affiliated dentists and dental practices located across three regions. This comprehensive process requires the creation and maintenance of provider files, the completion of credentialing applications and contracts, the gathering and verification multiple documents all within department standard operations procedures and service level agreements. The Specialist will also support the Provider & Plan Relations Manager by conducting research into insurance payers, gathering and organizing data, participating in the organization and maintenance of fee schedules, and other administrative functions as directed. The Specialist will support corporate departments with resolving credentialingrelated accounts receivable and insurance operations issues as needed.

*This position pays between $15-$18/hour*

Essential Functions:

* Ensure accurate and timely processing of affiliated dentist hires, transfers and terminations
* for the purposes of credentialing, data analysis and provider directory management
* Coordinate the completion and submission of all required credentialing applications
* between the affiliated dentist and payer
* Manage and support data management processes to track and report credentialing and
* payerrelated data
* Act as a liaison between the affiliated dental practices, field operations and centralized
* departments
* Partner with centralized departments to troubleshoot outofnetwork payer issues and
* other payerrelated discrepancies as needed
* Cultivate and maintain relationships with payer points of contact to resolve discrepancies
* in an expedited manner
* Aid in process improvement opportunities to optimize departmental processes and
* achieve maximized efficiency
* Research, gather and organize data as needed, to support the preparation of fee schedule
* maintenance and other payerrelated information as needed
* Manage electronic claims enrollment and enroll new providers as needed, through third
* party vendor
* Participate in the creation and maintenance of shared information in electronic folders, emails
* and on Dental Bytes (intranet)
* Process all W9, 1099, 147C letters or any requests for information, in a timely manner
* Adhere to all company policies and procedures, including any applicable State or Federal
* regulations
* Participate in department meetings and activities as required
* Complete special projects and other job duties as directed

Experience/Skills/Abilities:

* Computer literate with MS Office Suite experience
* Strong and effective verbal and written communication skills
* Ability to speak in a professional up tone
* Effective problemsolving and thorough critical thinking skills
* Excellent organization and followup skills
* High degree of professionalism and professional image
* Energetic interpersonal and relationship building skills
* Maintain and support a culture of compliance, ethics and integrity
* Ability to work in a fast paced environment
* Strong initiative and able to exercise sound judgment within the workplace
* Positive attitude, change advocate, and a leader by example
* Minimum two years related work experience
* Credentialing/contracting experience preferred but not required
* Accounts receivable experience preferred but not required
* Dental insurance experience preferred but not required
* Associates / Bachelors Degree in Business or Healthcare Administration preferred

Work environment/Conditions:

* Overtime as needed to perform job duties
* Travel 10% as needed

Dallas, TX
Dallas, Texas