PROVIDER ENGAGEMENT PROFESSIONAL - NETWORK DEVELOPMENT AND RELATIONS - DENTAL
Humana - Santa Fe, NM
posted 4 months ago
About the position
The Provider Engagement Professional 1 plays a crucial role in developing and nurturing positive, long-term relationships with physicians, providers, and healthcare systems. This position is essential for supporting and enhancing both financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Professional 1's work assignments are typically straightforward and of moderate complexity, focusing on the growth and sustainability of the Humana Dental Network. In this role, the professional will work directly with the Provider Network to strengthen relationships and educate providers on the value of participating in the Humana Dental Network. Creating a mutually beneficial professional relationship with providers is key to the growth of the network. A significant aspect of this role is to foster an 'easy to do business with' environment for providers, which is vital for maintaining engagement and satisfaction. The responsibilities include collaborating with Dental Service Organizations (DSOs) and large group partners on credentialing and re-credentialing projects, assisting in claim resolutions, and providing support to provider offices on maintenance and service issues. The professional will also handle member/provider disputes, assist with contract issues, and proactively engage with offices regarding fee schedules and financial incentives. Additionally, the role involves processing terminations of providers, addressing provider concerns, and working with both internal and external teams to find solutions for providers in the assigned territory. The Provider Engagement Professional 1 will serve as the single point of contact for all dental offices and consultants, leading the development and execution of content during consultant meetings and educational forums. This position requires a proactive approach to problem-solving and a commitment to building strong relationships within the healthcare community.
Responsibilities
- Develop and grow positive, long-term relationships with physicians, providers, and healthcare systems.
- Educate providers on the value of participating in the Humana Dental Network.
- Create a mutually beneficial professional relationship with providers.
- Work with DSO and large group partners on credentialing and re-credentialing projects.
- Assist in claim resolutions for providers on all systems.
- Provide support to Provider Offices on maintenance and service issues.
- Assist with member/provider disputes and provide assistance to SIU and GA.
- Address provider concerns and overcome objections with the goal of network retention.
- Collaborate with internal and external teams to find solutions for providers in assigned territory.
- Lead the development and execution of content during consultant quarterly meetings and education forums.
Requirements
- 2+ years of experience with Dental platforms.
- Detail-oriented with proactive thought leadership and root cause problem resolution skills.
- Excellent oral and written communication skills.
- Ability to multi-task, manage multiple projects, and meet deadlines.
- Desire to learn and advance in the field.
- Experience with Excel and Outlook.
- Strong customer care/service experience.
- Strong proficiency in relationship building.
Nice-to-haves
- Bachelor's Degree.
- Experience in Account Management.
- 3-4 years experience in the Health Care industry.
- Experience working with MTV, CBIS, QicLink, DPNMS, CRM.
Benefits
- Medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Paid time off, including company and personal holidays.
- Volunteer time off.
- Paid parental and caregiver leave.
- Short-term and long-term disability.
- Life insurance.
