Full-Time Provider Contracting Manager
This role is responsible for managing all aspects of network contracting and reimbursement to assure a highly efficient network in accordance with the cost and quality requirements and guidelines within the program administration. The representative is responsible for building long-term relationships with provider offices and clients and negotiating on all provider contracting elements, reimbursement structure, technology promotion, and access to care. The role is responsible for provider negotiation, contracting and credentialing for all products, including Medicaid, Medicare Advantage, Marketplace and Direct to Consumer, Commercial and any blend of dental products. Negotiations and contract execution needs to take place with decision makers at the provider entities, including CEOs, Vice Presidents and other executive leadership at the provider offices as well as individual dentists depending on the office size, location and corporate entity.
PRIMARY JOB RESPONSIBILITIES:
Solicit and represent the DentaQuest brand to the provider community, including the potential network of providers and dental groups in assigned markets.
Effective negotiation of provider contracts and reimbursement.
Negotiate complex financial models including incentive programs, capitation or special deal contracts to maintain compliance and increase cost effectiveness and access to care as necessary.
Research competition in market and make recommendations to meet or exceed competition.
Build and maintain relationships with organized dentistry and other key stakeholders.
Create and lead presentations to dental advisory groups and other stakeholder organizations.
Obtain letters of recommendation from provider entities and individual providers that partner on pilot programs, efficiency projects and innovative solutions to effectively boost RFP responses and competitive positioning.
Continuous improvement on credentialing and contracting workflow process.
Ensure reports on status of providers are prepared accurately and distributed timely.
Provide recommended solutions to improving provider satisfaction.
Provide leadership and education to provider offices in filing credentialing apps electronically and support enrollment of EFTs and electronic EOBS.
Provide web portal training and support to providers for effective contracting and credentialing requirements.
Resolve escalated issues in a timely manner by working with the appropriate internal partners to ensure provider satisfaction and growth commitments from the network.
Develop and continually improve personalized presentations of company benefit programs and innovative solutions.
Recruit and contract participating and non-participating providers to higher levels of participation with additional products and improved business models.
Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate.
Support the increase of access for members by strengthening and expanding existing network.
Adhere to DentaQuest business processes.
Other duties as assigned.
Provider Contracting Manager – DSO
Effectively build, negotiate and manage Dental Service Organization national contracts (large national provider entities that provide care in multiple states.
Work with executive leadership (CEO, VP, etc) within the DSO to create network expansion partnerships, reimbursement models and innovative pilot programs.
Manage and provide oversight of issue resolution at the national level, working with local regional partners internally and externally to resolve and maintain high provider satisfaction.
Effectively educate and negotiate VBP/P4P model contracting with key partnerships (FQHC, DSO or other large entities)
Provide education and data to DSO on network performance for effective negotiation of program performance.
Bachelor’s Degree in Business, Health Care Administration (or relevant field) or equivalent work experience
5 years’ minimum health care contracting, medical and/or hospital contracting or equivalent sales experience.
Strong presentation, negotiation, organization, analytic and presentation skills.
Demonstrated relationship building/negotiation experience
Ability to work remotely, with minimal supervision.
Excellent verbal and written communication skills.
Ability to work independently and as part of a team.
Proficiency in Microsoft Office products (Excel, Word & PowerPoint)
Ability to meet multiple deadlines and to prioritize and organize multiple tasks with tight deadlines.
Ability to work in high-pressure environment with tight deadlines for results
Up to 50% local travel
Strong knowledge of Provider reimbursement models and contracting. Ability to understand provider performance and costs data for effective negotiating.
Ability to work in a traditional professional office setting.
Ability to effectively operate computer equipment.
Work schedule may vary and is determined by project schedules.
Ability to travel as projects dictate
Ability to efficiently operate all job-related office equipment.
Ability to communicate via telephone and work in virtual teams
The office environment is active with high voice levels and interruptions that may challenge hearing and concentration.
How to Applyhttp://gr.8job.co/smaDKGZV
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