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Dental Network Liaison - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | washington, District of Columbia |
About this job
POSITION SUMMARY
To manage Aetna's Dental Provider Networks, recruitment, service, support efforts for all dental products in each assigned market to achieve growth and earnings targets.
Fundamental Components:
-Act as the liaison with the Primary Care Dentists and Specialists in a specific geographic territory responsible for overall maintenance and territory management of the provider network, as a functional subject matter expert, demonstrating a strong understanding of Aetna's Dental Products and market position.
-Negotiation of contract language and provider compensation.
-Review quality and service reports with provider and appropriate staff, contacting Dental providers regarding quality reviews conducted where unacceptable results were obtained.
-Timely response to correspondence from Provider offices, included, but not limited to termination requests, tax id changes, hold requests, claim reimbursement, system, directory accuracy and various contractual issues. Documented resolution and follow through communicated to all parties.
-Presentation of DHMO and PPO plan design, compensation process, claim / encounter submission, and referral policies during new office orientations and reorientations via the telephone.
-Knowledge of the competitive market and Aetna's relevant competitive position, to include member appointment access.
-Presentation of Aetna's electronic capabilities for dental providers to achieve companies goals and targets, promote all EDI initiatives.
-Special Ad Hoc Project as assigned.
BACKGROUND/EXPERIENCE desired:
-Minimum 3 years experience in a Dental Managed Care environment interacting with dental offices
-Knowledge of dental terminology and CDT coding
-Dental Network Management: Provider Relations, Contract Negotiations, Provider retention
-Dental Network/Provider communications & education
-Dental Network/Provider compliance
-Proficiency with Microsoft Word, Outlook and Excel, including formulas
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Network Management/Contract negotiation/4-6 Years
Functional - Network Management/Provider relations/4-6 Years
Telework Specifications:
Full time WAH
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Professional
To manage Aetna's Dental Provider Networks, recruitment, service, support efforts for all dental products in each assigned market to achieve growth and earnings targets.
Fundamental Components:
-Act as the liaison with the Primary Care Dentists and Specialists in a specific geographic territory responsible for overall maintenance and territory management of the provider network, as a functional subject matter expert, demonstrating a strong understanding of Aetna's Dental Products and market position.
-Negotiation of contract language and provider compensation.
-Review quality and service reports with provider and appropriate staff, contacting Dental providers regarding quality reviews conducted where unacceptable results were obtained.
-Timely response to correspondence from Provider offices, included, but not limited to termination requests, tax id changes, hold requests, claim reimbursement, system, directory accuracy and various contractual issues. Documented resolution and follow through communicated to all parties.
-Presentation of DHMO and PPO plan design, compensation process, claim / encounter submission, and referral policies during new office orientations and reorientations via the telephone.
-Knowledge of the competitive market and Aetna's relevant competitive position, to include member appointment access.
-Presentation of Aetna's electronic capabilities for dental providers to achieve companies goals and targets, promote all EDI initiatives.
-Special Ad Hoc Project as assigned.
BACKGROUND/EXPERIENCE desired:
-Minimum 3 years experience in a Dental Managed Care environment interacting with dental offices
-Knowledge of dental terminology and CDT coding
-Dental Network Management: Provider Relations, Contract Negotiations, Provider retention
-Dental Network/Provider communications & education
-Dental Network/Provider compliance
-Proficiency with Microsoft Word, Outlook and Excel, including formulas
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
FUNCTIONAL EXPERIENCES
Functional - Network Management/Contract negotiation/4-6 Years
Functional - Network Management/Provider relations/4-6 Years
Telework Specifications:
Full time WAH
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Professional