Senior Provider Relations Liaison

Highmark Health

1d•Hybrid

About The Position

This job services United Concordia Dental's (UCD’s) clients by recruiting, training and servicing quality dental networks in assigned territory in a remote and mobile work environment. The role involves managing network contracts, including negotiations, contract development/renewal, and financial reimbursement. The liaison acts as an intermediary between the organization and UCD, meeting with dentists and office personnel, and responding to contractual and payment issues. Key responsibilities include ensuring compliance with contractual terms through regular on-site audits and actively participating in network management, training, monitoring, and enforcement of company policies and procedures to increase provider efficiencies.

Requirements

High School Diploma/GED
5 - 7 years of experience in healthcare/insurance industry or professional experience in presenting concepts and influencing others in varying audiences
Written and oral communication skills
Time management and organizational skills
Knowledge of ADA/CDT codes and general dental terminology
Negotiation skills
Ability to analyze situations, determine points of relevance and proper course of actions

Nice To Haves

Bachelor's Degree - Business
5-7 years of experience as Dental Operations, Revenue Cycle Management, Payer Relations Payer contracting and Payer strategy development
Strong understanding of the DSO landscape

Responsibilities

Identify and initiate contact with prospective providers.
Develop and follow up on leads in an established time frame, while incorporating a sound business plan strategy to support and execute recruitment efforts that include existing and prospective client needs and provider resignations/terminations.
Customize participating dental agreement forms for execution, analyze provider changes, facilitate provider file updates and draft confidentiality agreements.
Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.
Analyze and develop network retention strategies for follow up services to providers by establishing and maintaining contact and rapport with dental staff members, office managers, insurance coordinators, hygienists and dentists throughout an assigned territory by scheduling face-to-face meetings with dental offices.
Formally present and effectively communicate UCD's administrative and claim guidelines and policies, benefits of participation, fee schedules, plan designs, competitive position, product development, network options, strategic partnerships, utilization review, local/national client demographics and dentist distribution.
Interpret and articulate contractual language and address questions regarding participation with providers, network share/leasing arrangements, opt in/out options, reimbursement methods, compensation models, including pay for performance and value added benefits.
Meet with all identified practices in assigned territory to review practice financial and quality performance.
Perform effective on-site visits through educating providers on the financial advantages and marketing incentives of participation.
Train dental office staff on the use of automated services to ensure they utilize various means of automated communication, as well as, claims and electronic data interchange and electronic funds transfer.
Collaborate with sales and customer service to respond to client/broker/member inquiries regarding provider contract, claim/member issues or provider file/record/directory discrepancies.
Consult with dental director/dental advisors regarding clinical-related questions and policies, as well as, current dental terminology (CDT) changes, to resolve provider inquiries within a mutually agreed timeframe.
Act as subject expert with recommendations and data supporting development of network and sales strategy and support of leasing contract negotiation.
Develop and maintain leasing revenue targets.
Update network lease risk strategy in response to all market changes.
Communicate and maintain effective working relationships both internally and externally (providers, dental industry, organized dentistry and dental consultants) keeping management informed on related healthcare industry issues/topics.
Support competitive position in the marketplace by staying abreast of changes to the business climate.
Monitor provider reimbursement methods and PPO/DHMO/EPO network models and communicate changes to provider community and leadership team.
Develop and manage process improvement initiatives designed to maintain URAC accreditation of all network practices associated with government programs using continuous quality improvement principles.
Conduct, collect and analyze data from office site visits and reviews to continually improve the care and service to members and provide recommendations to internal customer supporting quality improvement programs.
Train dental office staff and providers on all updates to quality assurance guidelines, with state and local regulations and URAC accreditation requirements.
Conduct audits as needed.
Train and mentor team members, internal customers and sales/account managers on all aspects of network and provider relations.
Lead and/or manage internal projects as necessary
Other duties as assigned or requested.