Colorado Sr. Manager, Provider Engagement, DentaQuest
About The Position
Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK. Individuals must be located in the Colorado, Front-Range Area preferred. The opportunity: The Provider Engagement Sr. Manager is the primary point person for providers to improve their understanding of our benefit programs, policies and procedures. This position is responsible for provider networks regarding office education, technology promotion, network recruitment (expansion and strengthening utilization), and general on boarding of newly contracted providers. In addition, this role administers on-site office reviews as required by network rules and regulations.
Requirements
- 5 years’ experience in healthcare practice or managed care environment.
- 3 years’ supervisory/management experience
- Bachelor’s degree in Business, Healthcare Administration (or related field) or equivalent, relevant experience.
- Strong presentation skills.
- Excellent verbal and written communication skills.
- Ability to work independently and as part of a team.
- Knowledge of Microsoft Office.
- Proven problem-solving skills.
- Problem solving and training experience.
- Ability to make sound judgment conclusions based on data available with minimal supervision.
- Up to 25% travel required (primarily local)
Responsibilities
- Maintain network participation by providing support to dentists and dental office managers to improve their understanding 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.
- Recruit non-participating providers within cost and access goals.
- Negotiate special deals to maintain compliance and increase access in networks.
- Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.
- Vendor relationship management for provider-facing technologies.
- Facilitate Oral Health presentations to various educational institutions and organizations.
- Assist provider offices in filing their claims electronically.
- Serve as a liaison 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 health fairs, audits, dental summits, etc. throughout your designated market.
- Maintain and submit all required reports.
- Netminder management
- Assist in resolving elevated complaints and issues for clients, members and providers.
- Provider electronic file maintenance.
- Coordinate and implement appropriate performance management strategies for team members to include:
- Assist in the hiring process, including interviewing candidates
- Assist, train and motivate team members
- Evaluate and measure effectiveness of team members
- Assist in preparation of performance and wage evaluations in accordance with company policy
- Responsible for attendance and company approved time off for team members
- Participate in the determination and implementation of Performance Improvement Plans and performance management initiatives
- Other duties as assigned
Benefits
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
