Dental Provider Network Manager (Healthcare/Dental)

$68,640 - $85,000/Yr

Liberty Dental Plan - Tustin, CA

Full-time - Mid Level

Tustin, CA

Insurance Carriers and Related Activities

About the position

The Dental Insurance Provider Network Manager at LIBERTY Dental Plan is responsible for developing and managing a strong provider network in California. This role involves recruiting and retaining dental providers, ensuring compliance with company policies, and maintaining relationships with network providers. The position requires regular travel within the assigned region, which includes Central California, to meet the organization's objectives and support its providers effectively.

Responsibilities

• Recruit General Dentists and Specialists for various networks as assigned.
• Review competitor information and propose strategies to meet recruitment needs.
• Analyze existing network and determine if additional recruitment of providers is necessary.
• Research and analyze fee schedules within assigned territory to determine cost-effectiveness of contracting providers.
• Negotiate contract terms with existing and potential providers.
• Manage and service network providers within assigned territory according to established guidelines.
• Establish and maintain strong relationships with providers to assure stable networks.
• Coordinate resolution of provider and member issues with internal and provider staff.
• Assist and coordinate counseling of providers with aberrant utilization or questionable billing patterns.
• Educate and train providers on policies and procedures when necessary.
• Conduct orientation according to established guidelines.
• Verify and monitor assigned network for accuracy.
• Process facility changes and submit them timely to update internal systems.
• Assist with special projects as assigned by management.
• Ensure network compliance with annual Attestation requirements.
• Conduct service calls and site visits as required by contract.
• Complete and review quarterly reports.
• Review necessary contract documents for accuracy & completeness for submission at Intermediate Level.
• Create and maintain DSO/Group Contracts at Intermediate Level.
• Conduct external facing communication with client management and internal facing partners at Intermediate Level.

Requirements

• 2 Year / Associate Degree or equivalent experience required.
• 4 Year / Bachelor's Degree preferred.
• 2 Years of previous network management experience in Dental PPO or DHMO environment; dental office management, managed healthcare, sales, and/or customer service experience required.
• Knowledge of dental terminology.
• Strong verbal and written communication skills in English; bilingual a plus.
• Proficient in Microsoft Office specifically Word, Excel, and Outlook.
• Ability to negotiate fee schedules with providers.
• Detail-oriented with strong customer service skills.
• Strong organizational and time management skills at an Advanced Level.
• Ability to identify problems, research issues and follow through until resolved at an Intermediate Level.

Nice-to-haves

• Medicaid or Medicare experience preferred.
• Experience in processing provider contracts preferred.
• Previous sales and customer service experience OR network management experience strongly preferred.

Benefits

• Competitive pay structure and saving options.
• Excellent 401k retirement benefits with employer match.
• Medical insurance with low-cost premium for employee only coverage.
• 100% employer paid dental coverage for employees and eligible dependents.
• 100% employer paid vision coverage for employee only coverage.
• Company paid basic life and AD&D coverage.
• Long Term Disability coverage.
• Expansive wellness program including gym discounts.
• Employee Assistance Program.
• Generous vacation and sick leave with rollover ability.
• 10 paid company holidays.
• Tuition Reimbursement.
• Remote or Hybrid options for various positions.