Manager Dental Program

AmeriHealth Caritas; Newtown Square (Delaware County); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization is seeking a Manager of Dental Programs to oversee the dental plan's daily operations. This remote role involves fostering relationships with dental providers, managing contracts, and ensuring compliance with regulations. The ideal candidate will have a Bachelor's degree and relevant experience in the healthcare industry, along with strong communication and analytical skills. Join us to make a meaningful impact in healthcare!

Benefits

Flexible work solutions

Health insurance coverage

401(k)

Tuition reimbursement

Paid time off

Qualifications

• 3 to 5 years of experience in the healthcare or insurance industry.
• Certification as a Registered Dental Hygienist (RDH) or CDA/EFDA is a plus.

Responsibilities

• Manage the onboarding process for new providers and respond to inquiries.
• Ensure compliance with state and federal regulations.
• Analyze data to identify cost savings opportunities.

Skills

Communication

Interpersonal Skills

Customer Service

Problem-Solving

Analytical Skills

Education

Bachelor's degree

Master's degree

Tools

Relevant Software

Job description

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Job Summary:

This is a remote position and will support our health plans in the Eastern and Central time zones.

Under the supervision of the Plan Dental Director, the Manager Dental Programs is responsible for the daily operation of the dental plan by contributing to workflow development, training, monitoring, and implementation. This position is also responsible for building and maintaining positive working relationships between ACFC and its contracted dentists, vendors, and fully delegated vendor networks. The Manager, Dental Programs performs or delegates performance of orientation sessions, educational visits, outreaches, and functions as a proactive clinical liaison to increase access and ensure adequate care for members in ACFC provider’s offices and/or through fully delegated vendor networks. This position will also coordinate resolution of provider issues; stay knowledgeable about workflow and timeliness requirements; and provide organizational leadership in the development and operational areas of the ACFC dental programs.

Key Responsibilities:

• Foster strong relationships with dental providers through regular communication and proactive engagement.

• Manage the onboarding process for new providers, including orientation and training in non-delegated states.

• Respond to provider inquiries, resolve issues, and address complaints related to claims, benefits, and other plan-related matters.

• Manage provider contracts, including reimbursement negotiations, in non-delegated states.

• Ensure compliance with state and federal regulations.

• Assist providers with claims processing, resolve complex claims issues, and ensure timely payments.

• In non-delegated states, contribute to network expansion by recruiting new providers and maintaining existing relationships.

• Analyze data to identify cost savings opportunities and other trends, and prepare reports as needed.

• Work cross-functionally to resolve provider issues, communicate effectively with all involved parties, and access and care for members in our dynamic and innovative organization.

Education/Experience:

• Bachelor's degree required; Master's degree preferred.

• 3 to 5 years of experience in the healthcare or insurance industry.

• Certification as a Registered Dental Hygienist (RDH), or a Certified or Expanded Functions Dental Assistant (CDA or EFDA), is a plus.

• Strong communication and interpersonal skills.

• Excellent customer service skills.

• Knowledge of dental insurance and current dental terminology (CDT) codes.

• Familiarity with claims processing and provider enrollment.

• Problem-solving and analytical skills.

• Ability to work independently and as part of a team.

• Computer proficiency and knowledge of relevant software.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce makes our company more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, competitive pay, paid time off including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.