CareFirst– Dental Provider Relations Specialist

 

 

Job Title: Specialist, Dental Provider Relations

Location: Red Run /Owings Mills

Career Band:   A

Job ID #: 8672

PRINCIPAL ACCOUNTABILITIES:  Under the general supervision of the Dental Director and in coordination with Medical Affairs and Network Management divisions, the Dental Provider Relations Specialist’s accountabilities include, but are not limited to, the following:

1. Maintain, develop and expand dental provider networks for all CareFirst lines of business utilizing but not limited to access competitive analysis and Marketing and Sales needs.  Build and maintain positive provider relationships.  Act as a liaison and facilitate effective communication between the professional provider, vendor community and CareFirst.  Assure compliance with contracts, regulatory issues and corporate policies.

  1. Assist in the negotiation, implementation and management of professional provider network contracts in service area. In conjunction with CareFirst vendor specialist, act as a liaison with vendors in service area.
  2. Develop and maintain dental provider communications through CareFirst provider communication media.
  3. Function as the primary contact for providers and deliver high quality, timely, efficient and cost-effective customer service to produce a high level of provider satisfaction.  Working with other departments, within CareFirst to assist providers in obtaining resolution including but not limited to operational, complex claims and compliance issues for all lines of business.  Handles and responds to dentists via correspondence or in person to inquiries, concerns, and problems from providers and other departments.  Provides consistent interpretation and implementation of policies, provider procedures and benefits.
  4. Responsible for management of orientations and providing training, education and seminars for new and existing professional providers in assigned territories.
  5. 10% Search out and disseminate industry trends that may impact provider networks and other departments within CareFirst.  Report activities relating to Provider Services activities.
  6. Coordinate with a wide range of areas to identify and resolve provider issues.  Meets provider needs, implements projects, supports corporate initiatives and develops plans to improve quality, service and contractual relationships.  Participates with interdepartmental teams to improve provider service and customer satisfaction levels.

    QUALIFICATION REQUIREMENTS:


Required:  This position requires knowledge of CareFirst, it’s various networks, contracts, benefits, operations, subsidiaries and external clients.  The incumbent must have a working knowledge of the provider community, knowledge of various reimbursement methodologies and knowledge of dental and medical terminology and provider specialties.  The applicant should be educated in the health care delivery system and have 2-3 years experience in provider relations, provider service, presentation and contract negotiations.  Must be able to work independently and manage time effectively in a fast paced environment.  (A car is essential to travel within state and surrounding areas).

Abilities/Skills:
-Excellent written and oral communication skills
-Strong analytical skills
-Strong problem solving abilities
-Sound organizational and time management skills
-Proficient in computer software applications, including MS Word and Excel
-Ability to work independently
-Dental and Medical Terminology

Preferred:

College degree preferred or equivalent work experience in related field

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully.  Requirements may be modified to accommodate individuals with disabilities.

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.

Department:  Dental Provider Relations

 

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Must be eligible to work in the U.S. without Sponsorship

Please visit our website to apply: www.carefirst.com/careers

Please apply before:  July 4, 2016

Actual salary will be based on relevant job experience and work history.

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