Provider Partner, DentaQuest

Sun Life•Wellesley, MA

1d•$71,000 - $106,000•Onsite

About The Position

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all. Job Description: Location: Must live in Massachusetts The opportunity: The Provider Partner is the primary on site point person for providers to improve their comprehension of our benefit programs, policies and procedures. The Provider Partner handles provider networks with regard to office education, technology promotion, network recruitment (expansion and strengthening utilization), and onboarding of newly contracted providers. The Provider Partner also administers on-site office reviews as required by network rules and regulations. How you will contribute: Analyze and monitor provider cost reports on an ongoing basis in order to educate and improve providers’ cost and quality performance. Maintain network participation by providing aid to dentists and dental office managers to improve their awareness of all available benefit programs. Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email. Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims. Negotiate special deals to maintain compliance and increase access in weak networks. Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process. Facilitate Oral Health presentations to various educational institutions and organizations. Assist provider offices in filing their claims electronically. Serve as a partner with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary. Follow up with all termination letters submitted. Represent clients and company at trade shows, health fairs, audits, dental summits, etc. throughout the designated market. Maintain and submit all required reports. Assist in resolving elevated complaints and issues for clients, members and providers. Obtain letters of recommendation from providers. Develop complete understanding of the Office Reference Manuals. Develop and continually improve personalized presentations of company benefit programs Recruit participating and non-participating providers to higher level of participation for all applicable market LOBs. Manage CAP office performance Provide recommended solutions to market related issues. Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities. Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate. Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices. Resolve difficult claims issues in a timely manner by working with the appropriate internal resources to research and resolve such issues. Increase access for members by strengthening and expanding existing network. Help to maintain a secondary network.

Requirements

Bachelor’s Degree in Business, Healthcare Administration or related field (or relevant work experience)
3 years’ related work experience in healthcare environment
Strong presentation skills.
Excellent verbal and written communication skills.
Ability to work alone and as part of a team.
Knowledge of Microsoft Office.
Proven problem-solving skills.
Up to 50% local travel required
Problem solving and training experience.
Ability to make good judgment conclusions based on data available with minimal supervision.

Nice To Haves

Dental knowledge with five (5) or more years of office experience, preferred

Responsibilities

Analyze and monitor provider cost reports on an ongoing basis in order to educate and improve providers’ cost and quality performance.
Maintain network participation by providing aid to dentists and dental office managers to improve their awareness of all available benefit programs.
Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email.
Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.
Negotiate special deals to maintain compliance and increase access in weak networks.
Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.
Facilitate Oral Health presentations to various educational institutions and organizations.
Assist provider offices in filing their claims electronically.
Serve as a partner with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary.
Follow up with all termination letters submitted.
Represent clients and company at trade shows, health fairs, audits, dental summits, etc. throughout the designated market.
Maintain and submit all required reports.
Assist in resolving elevated complaints and issues for clients, members and providers.
Obtain letters of recommendation from providers.
Develop complete understanding of the Office Reference Manuals.
Develop and continually improve personalized presentations of company benefit programs
Recruit participating and non-participating providers to higher level of participation for all applicable market LOBs.
Manage CAP office performance
Provide recommended solutions to market related issues.
Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities.
Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate.
Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices.
Resolve difficult claims issues in a timely manner by working with the appropriate internal resources to research and resolve such issues.
Increase access for members by strengthening and expanding existing network.
Help to maintain a secondary network.

Benefits

At our company, we are committed to pay transparency and equity.
The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable.
Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location.
In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business.
We are dedicated to creating a work environment where everyone is rewarded for their contributions.
Join our talent community to stay connected until the time is right for you!
We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive.
We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate.
We encourage applications from qualified individuals from all backgrounds.
Life is brighter when you work at Sun Life
At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.
Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.
Enjoy a flexible, inclusive and collaborative work environment that supports career growth.
We’re proud to be recognized in our communities as a top employer.
Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.
Visit our website to learn more about our benefits and recognition within our communities.
We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business.
Please email thebrightside@sunlife.com to request an accommodation.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
We do not require or administer lie detector tests as a condition of employment or continued employment.
Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.