Provider Network Manager - West Coast Florida

USAble Life; Jacksonville (FL); Hybrid; USD 71,000 - 85,000; Full time

Benefits offered by this job

Hybrid position

Remote work with equipment

PTO from day one

11 paid holidays

401(k) with company match

Tuition reimbursement

Employee assistance program

Diversity & inclusion initiatives

Job summary

USAble Life in Florida is seeking a Provider Network Manager to oversee a large dental provider network, recruit and maintain relationships with providers, and promote policy alignment with plan design. This hybrid role offers remote opportunities with company equipment and strong career development.

The ideal candidate has 2+ years in provider networks or dental benefits, a Bachelor’s degree, and excellent communication skills.

Qualifications

• Bachelor's degree required with related experience substitution allowed.
• At least 2 years of related experience in a dental or managed care setting.
• Knowledge of dental terminology and CDT preferred.
• Bi-lingual is preferred.
• Strong communication and analytical skills.

Responsibilities

• Assist providers with contracting and credentialing processes.
• Maintain provider network databases and promote improvements.
• Conduct field visits to educate and build provider relationships.
• Resolve issues related to plans, policies, and payments with providers.
• Coordinate across departments to correct claims processing.
• Represent the provider perspective in decisions on dental program policies.
• Attend provider committee meetings and industry associations.

Skills

Provider network management

Contracting skills

Customer service

MS Office skills

Time management

Education

Bachelor's Degree

Tools

MS Office Suite

Job description

When it comes to making a meaningful difference in the lives of our customers and employees, USAble Life is always ready. We are a diverse group of individuals working together to go the extra mile. Through our DEI initiatives, employees feel empowered to bring their talents and voice to our culture.

Our passion for delivering the best products is matched only by our passion for our people. We are committed to making a meaningful difference in the lives of others which extends beyond our office walls. USAble Life has a long tradition of supporting our communities, and we're proud of the fact that our employees share that commitment.

We have been recognized as a "Best Places to Work" in Arkansas, Florida, and Hawaii. You'll be rewarded with opportunities for personal and professional development and opportunities for advancement. This, coupled with our engaging culture and a comprehensive benefits package, ensures we are committed to our employees.

Check out how we make a meaningful difference in the lives of others!

https://player.vimeo.com/video/518665804

What We Offer You:

• A culture that values employees and celebrates, empowers, and inspires a diverse workforce
• Outstanding and affordable benefits package
• PTO provided at date of hire
• 11 paid holidays
• 401(k) with up to 6% match; fully vested from day 1
• Remote opportunities with company-provided equipment
• Team-oriented, collaborative group of peers
• Career advancement opportunities
• Tuition Reimbursement
• Employee Assistance Program
• Inclusion Council and Employee Resource Groups
• Recharge Days and Volunteer Time Off
• This is a hybrid position.

Pay Transparency: Our salary ranges are structured to provide opportunities for growth and advancement within a role. As a result, most new hires are placed between the minimum and midpoint of the range based on qualifications and experience, while the top of the range is generally reserved for employees who have demonstrated sustained expertise and performance in the position. The anticipated starting pay for a Provider Network Manager is between $70,700 to $84,900. Pay is based on non-discriminatory factors including but not limited to work experience, education, location, licensure requirements, proficiency and qualifications, and company tenure & equity. In addition to base compensation, this role is eligible for an annual incentive plan based on company performance and individual performance.

Provider Network Manager Overview

Manages a large, complex dental provider network. Ensures dental members have access to high quality provider networks by recruiting and maintaining rapport with new and existing providers. Promotes positive relationships with providers and the associations that represent them. Is responsible for continuous training regarding plan policies and procedures to Provider office staff. Promotes technology solutions to reduce overall administrative costs. Maintains provider retention. Works with non-standard contracts including HCR, Medicare Advantage, and tiered networks. Strategically develop provider networks to anticipate and meet future market needs. Provider communication coordination of plan policies, procedures, manuals, and quarterly publications.

Essential Duties:

• Assists providers with all aspects of contracting to participate with dental plans including credentialing applications, reviewing contractual rights and responsibilities, explaining plan policies and procedures, negotiating fees or other terms, and obtaining signed agreements.
• Contributes and promotes continuous improvement to the provider network database processes
• Conducts regular field visits to providers in assigned areas to provide education and develop a positive relationship with the provider and office staff.
• Demonstrates knowledge on a wide range of subjects including plans and initiatives, policy issues, claims submission requirements, programs that are beneficial to providers, claims payment problems, or other matters raised by the provider or office staff
• Responds to provider inquiries about plans, policies, and payments. Assess inquiries to make sure they are properly defined and understood. These inquiries will often concern issues that are non-routine or more complex, and that require significant research
• Performs internal follow-up in response to escalated provider complaints or concerns
• Coordinates between multiple departments to correct processing of claims, or bring about changes in policies and procedures
• Attends meetings with provider committees, and professional associations and societies to promote the company's presence in the dental community.
• Assists internal decision-making affecting providers by representing the provider's perspective in response to proposed dental plan programs and policies
• Participates in process improvement and training activities as needed
• Develops strategic plans which anticipate and meet future market needs regarding provider networks
• Performs other related duties and responsibilities as assigned

Required Knowledge, Skills, and Abilities:

• Broad knowledge of business concepts, practices, and procedures to handle multiple complex tasks with minimal guidance and limited supervision
• Knowledge of dental terminology, CDT, dental procedures, and products is preferred
• Excellent communication skills including the ability to address a wide range of audiences
• Ability to work within time constraints and maintain attention to detail
• Proven strength in customer service skills
• MS Office skills
• Ability to prioritize workflow and work independently
• Experience with internal claims and provider database administration systems
• Ability to read, analyze and interpret general business periodicals, financial reports, legal documents, professional journals, technical procedures, or governmental dental regulations
• Ability to write reports, business correspondence and memos
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members in the business community
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, and volume
• Ability to define problems, collect data, establish facts, and draw valid conclusions
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables

Required Education and Experience:

• Bachelor's Degree - related experience can substitute
• 2 years of related experience
• Or, equivalent military experience

Preferred Education and Experience:

• Knowledge of dental reimbursement methodology, dental plan designs and provider contracts
• Contracting experience
• Certification(s) may be desired
• Bi-lingual is preferred

#USAL1

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.