Senior Network Relations Specialist
7 hours ago
CVS Health is seeking a highly skilled Network Relations Specialist to join our team. As a key member of our Dental Network DMO Recruitment team, you will be responsible for growing our DHMO Managed Care network nationally via phone and document in Salesforce.
Key responsibilities include recruiting dentists to join our DHMO network, negotiating fees and contracts, supporting internal and external partners, provider credentialing, travel as needed, supporting sales initiatives, and evaluating the network deficiencies to ensure access to care needs are met.
A strong knowledge of the DHMO product and markets is crucial to this role. You must be able to sell and influence providers to join the DHMO network.
As a primary resource for all dental products (DHMO, PPO, Medicare) for providers, sales and marketing, and Dental Service Centers, you will aid in the achievement of Aetna Key Performance Measures.
You will act as the liaison with Primary Care Dentists and Specialists in a specific geographic territory, responsible for overall maintenance and territory management of the provider network, as a functional subject matter expert, demonstrating a strong understanding of Aetna's Dental Products and market position.
Negotiation of contract language and provider compensation is also a key responsibility.
You will review quality and service reports with providers and appropriate staff, contacting Dental providers regarding quality reviews conducted where unacceptable results were obtained.
Timely response to correspondence from Provider offices, including termination requests, tax ID changes, hold requests, claim reimbursement, system, directory accuracy, and various contractual issues, is also required.
Documented resolution and follow-through will be communicated to all parties.
You will present DHMO and PPO plan design, compensation process, claim/encounter submission, and referral policies during new office orientations and reorientations via the telephone.
Knowledge of the competitive market and Aetna's relevant competitive position, including member appointment access, is also required.
You will present Aetna's electronic capabilities for dental providers to achieve Company goals and targets, promote all EDI initiatives.
Requirements- 1-3 years of experience building a DMO Managed Care Network nationally
- 1-3 years of experience in Dental network provider relations experience
- Solid focus on fee analysis and negotiations
- Independent and self-motivated with a collaborative team focus
- Demonstrates clear and effective, concise, and appropriate written and verbal communication abilities
- 1-3 years of experience in Recruitment of Non-Par offices
- Robust technical proficiency in Microsoft Office (Excel, Outlook, Word, PowerPoint)
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