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About the role
Key responsibilities & impact- Conduct provider outreach through in-person, video, phone, and email channels
- Provide provider training, orientation, coaching, and performance-improvement education
- Guide providers on eligibility confirmation, claims submission, payment, and available tools
- Conduct monthly and/or quarterly provider-group meetings and document issues, attendees, and action items
- Research claims and prior-authorization issues and route them for resolution
- Collaborate with Network Recruitment on contracting requests, inquiries, and network adequacy reviews
- Collaborate with Credentialing on document intake and provider inquiries
- Own relationships and performance for assigned provider groups as primary point of contact
- Document provider interactions, outreach, office visits, concerns, and issue resolution
- Communicate provider claims and directory reporting internally and externally
- Complete provider orientation for applicable product lines
- Support adoption of tools, portals, and digital processes
- Perform onsite facility reviews and quarterly face-to-face visits within the assigned territory or market
- Coordinate with Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, Account Management, and other teams
- Educate providers on state programs, group policies, health-plan policies, procedures, and regulations
- Investigate and respond to complex provider issues and update provider demographic information
- Respond to contract inquiries, provider education requests, and non-routine claim issues
- Maintain accurate records for reporting, accountability, and cross-functional communication
- Attend work-related events and conferences as an organizational representative
- Coach, mentor, and develop junior team members as applicable
Requirements
What you’ll need- Must reside in the state of Mississippi
- 1 to 2 years of dental office experience
- Comprehension of dental terminology
- High school diploma or equivalent; experience may substitute for education
- Valid driver's license with proof of auto insurance and ability to use your own vehicle
- Ability to travel up to 50%, including overnight trips or extended stays
- Maintain internet service with at least 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN
- Knowledge of health plan operations preferred
- Knowledge of provider/health plan contracts and agreements highly desired
- Intermediate proficiency with Microsoft Excel, databases, Microsoft Office, spreadsheets, word processing, presentation software, and data-analysis systems
- Ability to monitor provider capacity, performance, and network adequacy
- Ability to evaluate provider performance and network adequacy metrics
- Ability to analyze provider network composition, geographic access, and market conditions
- Ability to identify recurring provider issues and operational trends
- 1 year of provider credentialing and contracting process experience preferred
- 1 to 2 years of health insurance claims and data analysis experience preferred
- Preferred: Certified Dental Assisting National Board (DANB) certification or Certified Dental Assistant (CDA) certification
Benefits
Comp & perks- Skill-building, leadership development and philanthropic opportunities
- Medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period
- Life and disability insurance
- 401(k) with company match
- Tuition assistance
- Paid parental leave
- Backup family care
- Dynamic, modern work environments promoting collaboration and creativity
- Flexible time off, dress code, and work location policies
- Employee Resource Groups
- Social responsibility and volunteering opportunities
- Benefits, bonuses, and commission may be available