Provider Representative

Job Summary

Job Title: Provider Representative
Number of Positions: 1
Location: DDMI - Nashville
Location Specifics: Hybrid Position

Position Description

Supports participating dental providers in working with state DBM Programs, including TennCare ECF CHOICES DBM Program, TennCare 1915© DBM Program, CoverKids DBM Program, and TennCare Adult Dental DBM Program.

Primary Responsibilities

• Sets up and conducts annual office visits to all participating dental offices within assigned region.
• Supports providers with non-billing related issues, including education and outreach to those who do not routinely provide preventive services.
• Manages TennCare ECF CHOICES DBM Program and TennCare 1915© DBM Program, including managing adult dental benefits and benefit limits, Prior Authorization requests, electronic billing, compliance initiatives, and other program requirements.
• Maintains relationships with healthcare providers and collaborates with them to address and resolve issues, as well as obtain documentation to support the claim process.
• Monitors and analyzes providers’ performance and compliance with organizational policies and standards.
• Performs other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

Minimum Requirements

• An associate’s degree in business administration, communications, dental assisting, or dental hygiene, with four years of relevant experience.
• Strong communication and interpersonal skills to effectively interact with healthcare providers and internal teams.
• Ability to manage multiple tasks and prioritize effectively.
• Knowledge of healthcare regulations and standards is a plus.
• Must be physically located within the state of Tennessee.
• Requires travel of 10-25% throughout the state of Tennessee, and nationally as necessary.

Benefits

The company provides equal employment and advancement opportunities within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.