Provider Partner

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Analyze and oversee provider cost reports to educate providers and enhance cost and quality performance.

• Support network participation by assisting dentists and dental office managers with benefit programs.

• Inform providers about benefit and contract policies and procedures through office visits, phone calls, and emails.

• Advocate for the use of web applications, technology solutions, and electronic claims submission.

• Negotiate special agreements to ensure compliance and improve access in underperforming networks.

• Suggest enhancements to internal methods, procedures, and Quality Assurance processes.

• Conduct oral health presentations for educational institutions and organizations.

• Aid provider offices in the electronic claim filing process.

• Address inquiries regarding remittances, payments, benefits, claims, and eligibility.

• Follow up on provider termination notifications.

• Represent clients and the company at trade shows, health fairs, audits, dental summits, and related events.

• Compile and submit necessary reports.

• Resolve escalated complaints and issues for clients, members, and providers.

• Recruit providers and enhance participation across relevant market segments.

• Manage CAP office performance and offer solutions to market-related challenges.

• Organize and present information to providers and dental organizations.

• Identify opportunities for improvement, assess program feasibility, and provide recommendations.

• Enhance information exchange between the company and dental offices.

• Resolve complex claims issues using internal resources.

• Strengthen and broaden provider networks to improve member access.

• Assist in maintaining a secondary network.

⛳️ Requirements

• Must reside in Massachusetts.

• Bachelor’s Degree in Business, Healthcare Administration, or a related field, or equivalent work experience.

• Minimum of 3 years’ relevant experience in a healthcare setting.

• Preferred dental expertise with five or more years of office experience.

• Exceptional presentation skills.

• Strong verbal and written communication abilities.

• Capacity to work independently as well as collaboratively within a team.

• Proficiency in Microsoft Office.

• Demonstrated problem-solving capabilities.

• Up to 50% local travel may be required.

• Experience in problem-solving and training.

• Ability to make informed judgments based on available data with minimal oversight.

🏝️ Benefits

• Discretionary annual incentive award based on individual and company performance.

• Generous vacation and sick leave.

• Leading market paid family, parental, and adoption leave.

• Medical insurance coverage.

• Company-sponsored life and AD&D insurance.

• Disability programs.

• Partially funded sabbatical program.

• 401(k) employer matching.

• Stock purchase options.

• Employer-funded retirement account.

• Flexible, inclusive, and collaborative work environment.

• Support for career growth and development.