- Under general supervision, responsible for various dental provider services functions with an emphasis on working externally with the Plan's highest priority, high volume, strategic providers to educate, advocate and engage as valuable partners.
- Requires an in-depth knowledge of dental provider services and contracting subject matter expertise.
- Resolves complex dental provider issues that may cross departmental lines and involve Senior Leadership.
- Serves as a subject matter expert for other departments.
- Trains other Provider Services Representatives, as appropriate.
- 3 - 5 years customer service, provider service, or claims experience in a managed care setting.
- 3-5 years' experience in managed healthcare administration and/or Dental Provider Services.
- 5 years' experience in dental provider contract negotiations in a managed healthcare setting ideally in negotiating different dental provider contract types, i.e., physician, group and hospital contracting, etc.
- Working familiarity with various managed healthcare dental provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including but not limited to; fee-for service, capitation, and various forms of risk, ASO, etc.
- 5+ years' experience in managed healthcare administration and/or Dental Provider Services.
- 5+ years' experience in dental provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, i.e., physician, group and hospital contracting, etc.
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Senior Dental Provider Services Representative - Owensboro, KY, United States - Molina Healthcare
Description
JOB DESCRIPTION
Job Summary
Molina Health Plan Dental Provider Network Management and Operations jobs are responsible for dental network development, dental network adequacy and dental provider training and education, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulations. Provider Services staff are the primary point of contact between Molina Healthcare and the contracted dental provider network. They are responsible for the dental provider training, dental network management and ensuring knowledge of and compliance with Molina healthcare policies and procedures while achieving the highest level of customer service.
KNOWLEDGE/SKILLS/ABILITIES
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent dental provider contract, dental network development and management, or project management experience in a managed healthcare setting.
Required Experience
Preferred Education
Bachelor's or master's degree.
Preferred Experience
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
#PJHPO
Pay Range: $44, $97,362.61 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
