Provider Engagement Professional 1 Network Development and Relations-Dental - WAH Nationwide

Profile

Description

The Provider Engagement Professional 1 develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Professional 1 work assignments are often straightforward and of moderate complexity.

Responsibilities

The Provider Engagement Professional 1 - Network Development and Relations-Dental works directly with our Provider Network to develop and strengthen relationships. Educating our providers on the value of participating in the Humana Dental Network and creating a mutual professional relationship with those providers, is key to the growth of the Network. The ability to create an 'easy to do business with' environment for the providers is a key function of this role.


Work with DSO & large group partners on credentialing and re-credentialing projects.
Work with claims unit to identify and assist in claim resolutions for providers on all systems
Educate Provider Offices on all existing and new products and plans
Provide support to Provider Offices on all maintenance and service issues
Assist with member/provider disputes and provide assistance to SIU and G&A
Assist Provider Offices/Rental Partners with any contract issue.
Work proactively with offices regarding fee schedule and financial incentive discussions.
Work with Rental Partners to assure cost saving measures have been met.
Add/Term locations, associates and products to existing provider relationships
Provide support with new product roll-outs and assist in re-contracting efforts
Process terminations of providers


Required Qualifications


HS Diploma or equivalent
3 years of Provider Contracting, Network Management, Customer Care or Provider Relations experience
Excellent communication skills both verbal and written
Demonstrated ability to manage multiple projects and meet deadlines


Preferred Qualifications


Bachelor's Degree
Dental experience highly desirable
MTV
Provider at a glance (PAAG)
CBIS
Qiclink


Additional information


Schedule: Monday to Friday from 8 am to 5 pm.

Training: it will take approximately a week. It will be virtual

Work Location (Address): Work From Home Nationwide

% Travel: Less than 25%


Scheduled Weekly Hours

40

Company info

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