Provider Relations Manager

7 days ago

Long Beach, California, United States Dental Health Services Full time
Job Summary

The Professional Services Support Manager plays a pivotal role in overseeing the Professional Services Support department's personnel, activities, and functions. This individual partners closely with executive management, Operations, Professional Services field personnel, Sales personnel, Member Services, and other teams to ensure all professional dental providers qualify and meet regulatory and quality standards under Dental Health Services' various programs.

Key Responsibilities

  • Leads and directs the Professional Support Services departmental and team functions, including all direct reporting personnel assigned.
  • Plans, organizes, and manages all Professional Support Services activities for Dental Health Services.
  • Ensures day-to-day credentialing support and guidance is provided with a high degree of accuracy and timeliness.
  • Provides for and processes professional provider contracting and verification, as well as monitoring provider quality assurance.
  • Works closely with Professional Services and Sales/Contracting personnel to ensure efficiencies in provider support and services.
  • Manages and oversees responses to provider inquiries, ensuring completeness and accuracy.
  • Ensures compliance with regulatory agencies and regulations through monitoring, audits, and submissions.
  • Supports the preparation of Dental Health Services audits and filings as required.
  • Responsible for applicable and assigned vendor oversight and management, including competitive vendor evaluation and selection, establishing standards of performance, measuring, and analyzing performance to standards, problem/issue resolution, etc.
  • Performs any and all additional duties as requested and directed for this position.

Requirements

  • Minimum of 3 years of related experience.
  • An additional 5 to 7 years of work experience, including 2 – 4 years of experience in leading a team.

Preferred Qualifications

  • Strong knowledge of provider operations, contracting, credentialing, and provider-based problem resolution protocols and techniques.
  • Strong knowledge of applicable regulatory requirements and their application to Dental Health Services' plans and the relationships with professional dental providers.
  • Strong knowledge of HIPAA requirements in a healthcare setting, maintaining confidentiality and protection of information as required.
  • Strong vendor oversight and management methods and practices.
  • Strong written and verbal communication skills; strong team building and team management approaches; project management; and strong problem-solving techniques.
  • Proficient in managing and overseeing day-to-day department operations.
  • Effectively developing, implementing, maintaining, overseeing, and managing a wide variety of required and necessary professional provider support programs and activities.
  • Effectively providing plans, programs, and activities to advance the operations of the department and the enterprise.
  • Maintaining a high level of integrity and appropriate confidentiality in all activities and efforts.
  • Effectively managing vendors and resolving issues associated with vendor oversight.
  • Ability to work independently in the absence of supervision.

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