Provider Partner Consultant, DentaQuest (OKLAHOMA)

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. At Sun Life, we're driven by our Purpose: helping our Clients achieve lifetime financial security and live healthier lives. Our values shape how we work: caring, authentic, bold, inspiring, and impactful.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

About the role

The Provider Partner is the primary on-site point person for providers to improve their understanding of our benefit programs, policies, and procedures. The Provider Partner is responsible for provider networks with regard to office education, technology promotion, network recruitment (expansion and strengthening utilization), and onboarding of newly contracted providers. The Provider Partner is also responsible for administering on-site office reviews as required by network rules and regulations. Candidates must be located in Oklahoma.

Responsibilities

• Analyze and monitor provider cost reports on an ongoing basis in order to educate and improve providers’ cost and quality performance.
• Maintain network participation by providing support to dentists and dental office managers to improve their understanding of all available benefit programs.
• Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email.
• Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.
• Negotiate special deals to maintain compliance and increase access in weak networks.
• Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.
• Facilitate Oral Health presentations to various educational institutions and organizations.
• Assist provider offices in filing their claims electronically.
• Serve as a partner with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary.
• Follow up with all termination letters submitted.
• Represent clients and company at trade shows, health fairs, audits, dental summits, etc. throughout the designated market.
• Maintain and submit all required reports.
• Assist in resolving elevated complaints and issues for clients, members, and providers.
• Obtain letters of recommendation from providers.
• Develop complete understanding of the Office Reference Manuals.
• Develop and continually improve personalized presentations of company benefit programs.
• Recruit participating and non-participating providers to higher level of participation for all applicable market LOBs.
• Manage CAP office performance.
• Provide recommended solutions to market-related issues.
• Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental-related activities.
• Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs, and presenting recommendations when appropriate.
• Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices.
• Resolve difficult claims issues in a timely manner by working with the appropriate internal resources to research and resolve such issues.
• Increase access for members by strengthening and expanding existing network.
• Help to maintain a secondary network.

Requirements

• Bachelor’s Degree in Business, Healthcare Administration, or related field (or relevant work experience).
• 3 years’ related work experience in a healthcare environment.
• Strong presentation skills.
• Excellent verbal and written communication skills.
• Ability to work independently and as part of a team.
• Knowledge of Microsoft Office.
• Proven problem-solving skills.
• Up to 50% local travel required.
• Problem-solving and training experience.
• Ability to make good judgment conclusions based on data available with minimal supervision.

Qualifications

• Dental knowledge with five (5) or more years of office experience (preferred).
• Managed Care experience (preferred).

Pay

The salary range for this role is $60,500 - $90,800. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business.

Benefits

• Generous vacation and sick time.
• Market-leading paid family, parental, and adoption leave.
• Medical coverage.
• Company-paid life and AD&D insurance.
• Disability programs.
• Partially paid sabbatical program.
• 401(k) employer match.
• Stock purchase options.
• Employer-funded retirement account.
• Flexible, inclusive, and collaborative work environment that supports career growth.