Dental Network Provider Relations Specialist

Careington International; Frisco (TX); Vor Ort; USD 42.000 - 54.000; Vollzeit

Zusammenfassung

Careington International in Frisco, TX is seeking a motivated professional to support providers, members, and assigned clients via phone and written correspondence. You will handle inquiries, resolve billing and quality-of-care issues, and collaborate with compliance to address escalated cases.

Strong MS Office skills and insurance knowledge are required. Ideal candidates will communicate clearly, manage multiple tasks, and maintain professional phone demeanor.

Qualifikationen

• Proficient with MS Office Suite: Word, Excel, Outlook, Acrobat.
• Strong phone experience with inbound calls.
• Dental or medical insurance industry knowledge is a plus.

Aufgaben

• Act as liaison between providers, members and assigned clients.
• Answer calls from providers and handle inquiries in real time.
• Resolve provider calls to achieve one-call resolutions when possible.
• Contact provider offices to resolve member billing and quality-of-care grievances.
• Negotiate refunds from providers on behalf of members when overbilling occurred.
• Draft professional resolution letters for member inquiries.
• Educate provider offices on plan administration and participation over the phone.
• Assist in creating and distributing educational materials to the network.
• Audit offices for participation and plan administration.
• Collaborate with compliance on escalated issues as needed.
• Maintain thorough knowledge of Careington's Network Development functions.

Kenntnisse

Self-motivation

Problem solving

Conflict resolution

Time management

Communication skills

Phone etiquette

Tools

MS Office Suite

Jobbeschreibung

Careington International is a solutions-oriented company. An established leader, we have been a trailblazer in the field of discount health care since 1979. Over the years, our mission has remained the same, to create discount health programs that are marketable to the employer, profitable to the provider and economical for the member. In response to a growing demand for our products and services in recent years, our growth means that we continuously strive to recruit innovators to join our fast-paced, forward-thinking team.

Individuals who have prior experience within the dental or medical insurance industry are strongly encouraged to apply.

Duties & Responsibilities

• Act as liaison between providers, members, and act as the dedicated liaison for assigned clients
• Answer phone calls from providers and handle inquiries in real time
• Resolve provider calls effectively and efficiently, with the intent for one-call-resolutions when possible
• Contact provider offices to resolve member billing and quality of care grievances
• Negotiate refunds from provider offices on behalf of the member if overbilling has occurred
• Professionally write resolution letters due to member billing or quality of care inquiries
• Educate provider offices on plan administration, plan participation, and other facets of Careington's network by phone
• Work with marketing and team to create education materials and distribute them to the network
• Audit offices for participation and plan administration
• Work with compliance on addressing escalated issues
• Willing to perform all other responsibilities as assigned and assist in other department projects as needed
• Maintain a thorough working knowledge of Careington's Network Development department and functions

Knowledge, Skills, And Abilities

• Must be a self-motivator with a high desire to add value to the day to day operations of the department
• Possess high level problem solving and analytical thinking skills that will assist in making independent judgment decisions to provider/member inquiries
• Strong conflict resolution skills to de-escalate
• Have a strong sense of time management and organizational skills with the ability to effectively manage various daily tasks
• Must be able to retain and apply learned information to all request presented
• A strong knowledge of basic mathematical calculations is required
• Impeccable communication skills - both written and verbal
• Must have professional phone demeanor and superb listening skills for callers

Minimum Qualifications And Requirements

• Proficient within MS Office Suite products: Word, Adobe, Excel, Outlook
• Phone experience; engaging with inbound callers
• Dental or medical insurance industry knowledge is a plus