Provider Relations Representative
Job Description
About Florida Dental Benefits
Florida Dental Benefits provides managed care dental services to HMOs, Discount Medical Plans, Medicare Advantage Plans, employers and individuals. We are focused solely on providing quality dental benefits. For us, ancillary benefits are our top priority, not a secondary product offering. We have recently acquired several large contracts providing an exciting opportunity for job opportunities and growth within the organization.
Position Description
Responsible for maintaining working relationship with the existing network of participating dentists for a specific geographic area. Assists providers with policy and procedure interpretation. Achieves company targets through the implementation of network improvement plans. Assists with recruitment of new providers.
Responsibilities
- Develops strong interpersonal relationships with assigned providers and maintains regular contact with key contacts.
- Researches and resolves incoming provider inquiries.
- Ensures provider network compliance. Assist with business intelligence and market analysis reports.
- Continuous education and outreach to providers on protocols, policies, and procedures. Ensures that the provider network size and stability meets client growth needs.
- Assists with recruitment by identifying network gaps and prospective providers within a designated territory.
- Facilitates the distribution of provider agreements, negotiates rates, and renegotiates contracts. Conducts Quality Management follow-up; coordinates grievance information, including contact with office, record retrieval and resolution follow-up. Coordinates with Utilization Management to monitor provider utilization patterns. Participates on assigned committees to provide ongoing feedback using market conditions, industry trends, and provider insights. Assists with creation, modification or update of standard and non-standard provider agreements and fee schedule addendums. Reviews, analyzes and manages provider reimbursement schedules to ensure that they are cost-effective and meet the recruitment needs. Reviews and analyzes internal data to determine network improvement needs.
- Conducts provider office site visits to ensure offices meet established guidelines.
- Ensures provider database and documentation is up-to-date, accurate, and complete. Collects competitive information for ongoing competitor analysis and process improvement
- Completes new provider orientation for all applicable product lines and ensures new contracts are entered promptly and accurately.
- Assists with credentialing and recredentialing of provider offices.
- Assists with the development and implementation of provider training programs.
- Analyzes changing business requirements; makes recommendations to management for process improvements.
- Participates in strategizing for membership growth and retention.
- Performs other duties as required.
Provider Relations Representative
Job Description
Qualifications
- Bachelor's degree or equivalent experience.
- Previous customer service experience with exposure to benefits interpretation and provider networking.
- Previous experience as a Provider Relations Representative.
- Knowledge of managed care policy, benefit plan design, and provider fee schedules desired.
- Ability to explain complicated financial terms and utilization data to dentist/staff.
- Excellent written, verbal and public speaking skills.
- Strong analytic and problem solving abilities.
- Strong communication and negotiation skills.
- Valid driver’s license and reliable transportation are required as local travel is required
Job Type: Full-time
Pay: $28.00 - $35.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Paid time off
Education:
- High school or equivalent (Required)
Experience:
- Communication skills: 1 year (Required)
- English: 1 year (Required)
- Microsoft Word: 1 year (Preferred)
- Medical management: 1 year (Preferred)
- Dental office: 1 year (Preferred)
Work Location: In person
