Provider Partner Consultant

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

📋 Description

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

• Assist dentists and dental office managers in comprehending benefit programs, policies, and procedures.

• Provide education to providers through in-person visits, phone calls, and email communications.

• Advocate for web applications, technological solutions, and the adoption of electronic claims.

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

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

• Conduct oral health presentations for educational institutions and organizations.

• Support provider offices with the submission of electronic claims.

• Address inquiries related to remittance, payment, benefits, claims, and eligibility.

• Follow up on letters regarding provider terminations.

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

• Maintain and submit necessary reports.

• Assist with escalated complaints and issues for clients, members, and providers.

• Develop tailored presentations of company benefit programs.

• Recruit providers and enhance participation across relevant market lines of business.

• Manage CAP office performance and propose solutions to market challenges.

• Organize and present information to providers and their teams.

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

• Enhance the information exchange between the company and dental offices.

• Resolve complex claims issues using internal resources.

• Strengthen and expand provider networks to increase member access.

• Assist in maintaining a secondary network.

⛳️ Requirements

• Candidates must reside in Oklahoma.

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

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

• Strong skills in presentation delivery.

• Exceptional verbal and written communication abilities.

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

• Proficiency in Microsoft Office.

• Demonstrated problem-solving skills.

• 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 supervision.

• Preferred: Knowledge of dental practices with five or more years of office experience.

• Preferred: Experience in managed care.

🏝️ Benefits

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

• Generous vacation and sick leave.

• Market-leading paid family, parental, and adoption leave.

• Medical insurance coverage.

• Company-paid life and AD&D insurance.

• Disability programs.

• Partially paid sabbatical program.

• 401(k) employer matching.

• Stock purchase options.

• Employer-funded retirement account.

• Flexible, inclusive, and collaborative work environment.

• Support for career growth.

• Reasonable accommodations for qualified individuals with disabilities or special disabled veterans.