Provider Relations Liaison

📋 Description

• • Recruit, train, and service quality dental networks within an assigned territory through a remote and mobile work environment, acting as the primary liaison between United Concordia Dental and dental providers.
• • Identify and initiate contact with prospective dental providers, develop leads within established timeframes, and execute recruitment strategies aligned with client needs and provider resignations or terminations.
• • Customize and execute participating dental agreements, analyze provider changes, facilitate file updates, and draft confidentiality agreements to ensure accurate provider records.
• • Monitor financial performance of provider contracts by tracking utilization rates, competitive market conditions, and group-specific performance guarantees.
• • Conduct face-to-face meetings with dentists, office managers, insurance coordinators, and hygienists to build rapport, communicate UCD’s administrative and claim guidelines, fee schedules, plan designs, and network options.
• • Interpret and articulate complex contractual language regarding participation, network share/leasing arrangements, opt-in/out options, reimbursement methods, compensation models, pay-for-performance, and value-added benefits.
• • Perform on-site visits to educate providers on financial advantages and marketing incentives of participation, and train dental office staff on automated services including claims processing, electronic data interchange, and electronic funds transfer.
• • Collaborate with sales and customer service teams to resolve client, broker, or member inquiries related to provider contracts, claims, or provider directory discrepancies.
• • Consult with dental directors and advisers on clinical-related questions, current dental terminology (CDT) changes, and policy interpretations to resolve provider concerns within agreed timeframes.
• • Serve as a subject matter expert to support network and sales strategy development, including leasing contract negotiations and updating network lease risk strategies in response to market changes.
• • Develop and maintain leasing revenue targets while ensuring alignment with organizational goals and market dynamics.
• • Communicate effectively with internal teams and external stakeholders including providers, dental industry professionals, organized dentistry, and dental consultants, keeping leadership informed on healthcare industry trends.
• • Maintain competitive positioning by monitoring provider reimbursement methods and PPO/DHMO/EPO network models, and communicating changes to the provider community and internal leadership.
• • Develop and manage process improvement initiatives to maintain URAC accreditation for network practices associated with government programs using continuous quality improvement principles.
• • Conduct on-site audits and data collection from provider offices to evaluate care quality and service delivery, providing recommendations to support internal quality improvement programs.
• • Train dental providers and office staff on updates to quality assurance guidelines, state and local regulations, and URAC accreditation requirements.
• • Ensure compliance with contractual terms through regular on-site audits and adherence to company policies and procedures.
• • Maintain knowledge of ADA/CDT codes and general dental terminology to effectively communicate with providers and resolve technical inquiries.
• • Travel up to 25% to conduct in-person visits, audits, and training sessions across the assigned territory.
• • Lift and carry items weighing up to 10 pounds constantly and up to 25 pounds occasionally as needed during site visits.
• • Adhere to HIPAA, data security policies, and the Company’s Code of Business Conduct when handling protected health information and confidential data.