Dental Network Liaison

Health Plan of San Mateo -posted 2 months ago
South San Francisco, CA
101-250 employees
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The Dental Network Liaison coordinates and facilitates initiatives both internally and with Health Plan of San Mateo (HPSM) contracted providers to support adequate network access for HPSM members. Responsibilities include organizing provider meetings, implementing and maintaining pilot initiatives and payment models, and supporting objectives related to population health outcomes, member experience, and financial stability.

  • Develop and maintain an understanding of provider operations and priorities specific to dental provider specialty areas.
  • Facilitate internal and provider outreach and develop communication materials to support provider partnerships.
  • Contribute to provider recruitment efforts to support network development programs and report information gathered from provider visits.
  • Conduct online webinars and in-person workshops to familiarize providers with HPSM procedures and processes. Conduct individual provider follow-up as needed.
  • Coordinate activities across multiple clinical settings and stakeholders to develop and maintain relationships with providers and staff.
  • Identify provider and member needs, offer recommendations to improve outcomes and incentivize participation, and support HPSM quality and process improvement initiatives through education and program development.
  • Diplomatically and creatively resolve escalated or complex provider issues using strong professional judgment and discretion.
  • Act as the primary point of contact for provider grievances, ensure prompt provider responses, and conduct root cause analysis to prevent similar issues from arising in the future.
  • Represent Provider Services/HPSM in internal and external meetings.
  • Produce and disseminate clear information and reporting dashboards to educate and engage providers and internal staff about payment models, provider contracts, and HPSM provider program requirements.
  • Stay current on California Department of Healthcare Services (DHCS), Centers for Medicare & Medicaid Services (CMS), and California Department of Managed Health Care (DMHC) policy updates and changes.
  • Bachelor’s degree in a health-related field or similar field and five (5) to seven (7) years of experience in insurance, dental, healthcare, or related field preferred.
  • Or eight (8) to ten (10) years of experience in a provider services or provider network role.
  • Advanced communication skills, both verbally and in writing.
  • Advanced proficiency in personal computers and Microsoft Office Suite, including Outlook, Word, Excel, Teams, and PowerPoint.
  • Advanced skills in conducting effective meetings with both internal and external stakeholders.
  • Advanced negotiation skills to resolve provider issues.
  • Expert knowledge of insurance claims and billing procedures.
  • Extensive knowledge of value-based payment methodologies.
  • Working knowledge of process improvement methodology.
  • Working knowledge of population health management, managed care protocols, as well as Medi-Cal and Medicare.
  • Demonstrated ability to communicate effectively, both verbally and in writing; handle complex issues with diplomacy; maintain a professional demeanor in stressful situations; and establish cooperative working relationships with internal and external stakeholders.
  • Demonstrated ability to organize and prioritize tasks and deliver results within set deadlines.
  • Ability to perform research and clearly summarize information.
  • Ability to be proactive and demonstrate initiative; work independently and use sound judgment.
  • Ability to be detail-oriented and accurate.
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