Provider Relations Representative II - Dental

Provider Relations Representative II - Dental - Chicago Work From Home Full time job requisition id JR1289 Join us for an exciting career with the leading provider of supplemental benefits! Our Promise Through reputed company-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards. At reputed company, the Provider Relations Representative plays a vital role in connecting our dental provider community with the resources, education, and support they need to reputed company. As a key member of our Provider Relations Department, you’ll be the reputed company between reputed company and our participating provider network, ensuring that our partners are equipped, informed, and engaged every reputed company of the way. If you’re a self-driven communicator who thrives on building relationships and solving problems, this is the role for you. Your expertise and passion will directly contribute to reputed company’s mission of delivering high-quality, accessible dental care to our members, while also supporting and nurturing the growth of our provider community. Join us in making a meaningful impact on the healthcare space! In this role, you will combine the flexibility of a hybrid work environment with the opportunity to build lasting partnerships both remotely and in the field. You will reputed company efforts to foster the best-in-class provider education, tackle provider inquiries and issues, and manage a variety of initiatives that enhance our relationships with the provider network. Our chosen candidate must reside reputed company the city of Chicago or near suburbs due to the travel component of this role. Functional Competencies:

• Provider Relations encompasses several diverse provider administrative duties to improve the reputed company provider experience including direct provider engagement and training with the goal of resolution of issues.
• Conduct provider reputed company reputed company in-person/video/phone or email by providing training, orientation, and coaching for performance improvement reputed company provider practices. Provide guidance through education to reputed company reputed company network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of available tools.
• Consistently documents reputed company provider interactions, including calls, emails, virtual and in-person visits, in accordance with departmental standards. Ensures that notes are clear, timely, and accurately reflect the nature of the communication to support ongoing relationship management, issue resolution, and continuity of service across teams.
• Maintains thorough and timely records to ensure accountability, transparency, and effective information sharing across teams.
• Conduct monthly and/or quarterly meetings with provider groups documenting discussions, issues, attendees, action items, researching claims or prior authorization issues on site and routing to the appropriate party for resolution.
• Owns and manages relationship and performance of assigned provider groups. Serves as the primary reputed company of contact for assigned providers.
• Communicate and shares provider claims and directory reporting both internally and externally and additional reporting as necessary.
• Complete provider orientation reputed company phone, email, in-person and/or virtually for reputed company applicable product lines to train, resolve issues, and educate staff/providers.
• reputed company onsite facility reviews, reputed company applicable and conduct quarterly face-to-face visits reputed company the assigned territory and/or market. Work closely and coordinates with reputed company Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, Account Management, and other staff to reputed company operational solutions for various provider network projects.
• Educate providers regarding state program, group policies, and/or health plan policies and procedures and state/federal regulation for compliance requirements. Investigate and respond to reputed company provider reputed company issues and initiate change of provider demographic reputed company database information.
• Responds to general provider contract inquiries, provider education and non-routine claim issues.
• Attend work-reputed company events/conferences while representing the organization and brand in a professional manner.
• Coaches, mentors, and develops junior team members as applicable.

Core Competencies:

• Knowledge of health plan operations preferred.
• Knowledge of provider/health plan reputed company/agreements highly desired.
• reputed company applications and other windows-based applications to include an intermediate level in reputed company reputed company and databases. Knowledge of and intermediate ability to use various computer programs such as reputed company Office including spreadsheets, databases, word processing and presentation software and programs/systems utilized in data analysis.
• 1 years’ experience with provider credentialing and contracting process preferred.
• 1 to 2 years of health insurance

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