NY Provider Partner Consultant, DentaQuest

Sun Life•New York, NY

12d•$63,000 - $94,500•Remote

About The Position

The Provider Partner Consultant handles developing and managing relationships with providers within their assigned market. As such, this role spends most time communicating with providers about suite of benefit programs (Medicaid, Medicare Advantage, Marketplace and Direct to Consumer and Commercial and any blend of dental products) to aid DLR in risk markets, and the P&L of the network. The Provider Partner Consultant works collaboratively with reporting to discern provider reports and promote continuous improvement top Providers (high performance metrics, cost, outliers, quality, etc.)

Requirements

Dental knowledge with five (5) or more years of office experience.
Managed Care experience
Strong presentation skills
Excellent verbal and written communication skills
Ability to work independently and as part of a team
Knowledge of Microsoft Office
Ability to travel up to 50% locally

Responsibilities

Maintain visibility within their market, with an eye toward managing their network across all product lines.
Evaluate and monitor provider cost reports on an ongoing basis to educate and improve providers’ cost and quality performance.
Handles recruiting new providers and maintaining network participation by aiding dentists and dental office managers to improve their awareness of all available benefit programs.
Responsible for educating providers, serve as primary point of contact for instruction and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email.
Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.
Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.
Facilitate Oral Health presentations to various educational institutions and organizations.
Represent clients and company at trade shows, health fairs, audits, dental summits, etc. throughout the designated market and/or state.
Governs creation and submission of all required reports.
Acts as a subject matter expert for their respective geographic area
Develop complete grasp of the Office Reference Manuals for implementation within their region.
Develop and continually improve personalized presentations of company benefit programs
Provide recommended solutions to market related issues.
Measure impact of provider satisfaction (as tied to annual objectives of the team) and respond to provider issues.
Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities.
Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate.
Performs in depth investigation of fee schedules, including fee schedule comparisons, to negotiate competitive custom fee schedules where needed
Provides regular updates to senior management on internal and external issues affecting network market performance.
Develop and implement processes to improve overall client and provider satisfaction
Develop and maintain relationships with appropriate functional areas to ensure effective contract performance
Aid innovative business practices and process improvement opportunities for current and prospective clients.
Maintain a secondary network to ensure access to care for all eligible members.
Other duties as assigned