Initiates and leads activities related to the administration, monitoring, and oversight of the Commercial EmblemHealth Dental PPO Provider Networks. Oversight of the integrity of the Fastrak provider file, compose, support and facilitate Credentialing compliance and protocols, establish and maintain Quality Assurance matrix for Service and Clinical Complaints, and provide guidance for member and dental provider resolutions. Interdepartmental liaison for project management and maintain open communication. Provides leadership to the department to ensure that projects and departmental objectives are achieved with a sense of urgency. Will also be maintaining additional responsibilities for a Network Specialist that was not replaced. This includes, but is not limited to, maintaining the dental Fastrak and Access databases, processing dental provider applications, scanning for disaster recovery (Softheon web based program), filing and preparation for trade shows.
Initiates and leads activities related to the administration, monitoring, and oversight of all dental network activities; develops and implements recruitment strategies for geo-access and sales support, contracts and conducts PR visits weekly. Directs, supervises, and provides weekly team huddles and as needed training for staff as well as provide positive leadership for staff's professional growth.
Works closely with all departments to identify and resolve systemic issues to provide support necessary to resolve such issues to reinforce provider/member retention and growth goals. Also collaborates to produce and verify data needed to efficiently pay dental claims and resolve service/clinical related member/provider issues.
Maintain additional responsibilities for a Network Specialist that was not replaced. This includes, but is not limited to, maintaining the dental Fastrak and Access databases, processing dental provider applications, scanning for disaster recovery (Softheon web based program), filing and preparation for trade shows.
As relationship manager for the credentialing vendor-Initiates and leads activities related to the credentialing process, and participates in Due Diligence activities to assure a dental network of high quality and integrity. Maintains Quality Assurance Matrix of providers- clinical and service related issues.
Initiates and manages projects to support dental product reliability and up to date communication i.e. web site, provider manuals, orientation materials, recruitment, contract initiatives.
Develops and maintains departmental data bases to support analytical reporting needs.
Volunteers on behalf of EH/GHI on NADP various workgroups. Identifies, oversees and participates in key Dental trade conferences.
Supports Internal audits from SOX & SAS teams.
Support Sales and Account Management requirements for commercial dental PPO products.
Regular attendance is an essential function of the job. Performs other duties as assigned or required.
5 or more years of experience in managed care/health care with minimum 5 years in ancillary programs. Dental benefits background preferred
5 or more years clinical experience in a dental setting required
Knowledge of the health care industry and health care products required
Understanding of dental provider credentialing/contracting and dental claims systems required
Familiarity with dental provider community required
Knowledge of dental network models, laws, and regulations required
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.