Provider Relations Field Representative (Doral)

Become part of Doral Dental, a DentaQuest Ventures company, delivering governmental dental programs and serving over seven million members in 17 states. Doral is looking for talented individuals to join its team working on-site at DentaQuest Ventures, headquartered in Boston, MA, and wants to hear from you! Successful candidates will have applicable experience and education for the position for which they are applying, be able to work autonomously and demonstrate sound decision making, have a great work ethic, and excellent interpersonal and communication skills.

Provider Relations Field Representative

This role will be the primary contact for individual provider issues. These individuals will also conduct regular visits scheduled through Massachusetts to assist in resolution of issues and promotion of Doral and its services, and recruit new providers into the network.

Responsibilities:
• Contact the top 25 Massachusetts providers and visit twice yearly.
• Contact participating Massachusetts dental offices to proactively resolve issues and strengthen relationships.
• Assist provider offices in filing their claims electronically.
• Serve as a liaison between dental offices and Doral Dental by answering remittance, payment, benefit, claims, and eligibility questions when necessary.
• Update Supervisor of Provider Relations regularly on major issues, both internal and external.
• Provide recommended solutions to Supervisor of Provider Relations to Massachusetts market issues.
• Increase access for members by strengthening and expanding existing network.
• Monitor provider networks using GEO and work with network development to ensure adequate networks.
• Recruit participating and non-participating providers to higher levels of participation.
• Follow up with missing credentialing and re-credentialing information as assigned.
• Follow up with all termination letters submitted.
• Help to maintain a Secondary Network.
• Complete all assigned site visits within 21 days.
• Represent clients and Doral at health fairs, audits, dental summits, etc throughout the Commonwealth of Massachusetts.
• Develop complete understanding of the Office Reference Manuals.
• Develop and continually improve personalized presentations of Doral (present Doral and dental programs via telephone and in person)
• Maintain and submit all required reports.
• Assist in resolving complaints and issues for clients, members and providers.
• Obtain letters of recommendation from providers.
• Participate in the determination and implementation of corrective action plans.
• Perform miscellaneous tasks including, but not limited to, assisting with projects as assigned by Supervisor of Provider Networks.
REQUIREMENTS
•College degree
• Knowledge of general computer software (Excel, MS Word, and Access a plus)
• Knowledge/experience in health or dental care
• Insurance license would be beneficial
• Excellent verbal communication skills
• Excellent interpersonal skills
• Ability to prioritize and organize multiple tasks.
• Ability to remain organized with multiple interruptions
• Good PC skills. Typing helpful.