Provider Network Manager - West Coast Florida

When it comes to making a meaningful difference in the lives of our customers and employees, USAble Life is always ready.  We are a diverse group of individuals working together to go the extra mile. Through our DEI initiatives, employees feel empowered to bring their talents and voice to our culture. 

Our passion for delivering the best products is matched only by our passion for our people. We are committed to making a meaningful difference in the lives of others which extends beyond our office walls. USAble Life has a long tradition of supporting our communities, and we’re proud of the fact that our employees share that commitment.   

We have been recognized as a “Best Places to Work” in Arkansas, Florida, and Hawaii. You’ll be rewarded with opportunities for personal and professional development and opportunities for advancement.  This, coupled with our engaging culture and a comprehensive benefits package, ensures we are committed to our employees.    

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Manages a large, complex dental provider network. Ensures dental members have access to high quality provider networks by recruiting and maintaining rapport with new and existing providers. Promotes positive relationships with providers and the associations that represent them. Is responsible for continuous training regarding plan policies and procedures to Provider office staff.  Promotes technology solutions to reduce overall administrative costs. Maintains provider retention.   Works with non-standard contracts including HCR, Medicare Advantage, and tiered networks.  Strategically develop provider networks to anticipate and meet future market needs.  Provider communication coordination of plan policies, procedures, manuals, and quarterly publications.

• Assists providers with all aspects of contracting to participate with dental plans including credentialing applications, reviewing contractual rights and responsibilities, explaining plan policies and procedures, negotiating fees or other terms, and obtaining signed agreements. 
• Contributes and promotes continuous improvement to the provider network database processes
• Conducts regular field visits to providers in assigned areas to provide education and develop a positive relationship with the provider and office staff. 
• Demonstrates knowledge on a wide range of subjects including plans and initiatives, policy issues, claims submission requirements, programs that are beneficial to providers, claims payment problems, or other matters raised by the provider or office staff
• Responds to provider inquiries about plans, policies, and payments. Assess inquiries to make sure they are properly defined and understood.  These inquiries will often concern issues that are non-routine or more complex, and that require significant research
• Performs internal follow-up in response to escalated provider complaints or concerns 
• Coordinates between multiple departments to correct processing of claims, or bring about changes in policies and procedures
• Attends meetings with provider committees, and professional associations and societies to promote the company's presence in the dental community.
• Assists internal decision-making affecting providers by representing the provider's perspective in response to proposed dental plan programs and policies
• Participates in process improvement and training activities as needed
• Develops strategic plans which anticipate and meet future market needs regarding provider networks
• Performs other related duties and responsibilities as assigned

• Broad knowledge of business concepts, practices, and procedures to handle multiple complex tasks with minimal guidance and limited supervision
• Knowledge of dental terminology, CDT, dental procedures, and products is preferred
• Excellent communication skills including the ability to address a wide range of audiences
• Ability to work within time constraints and maintain attention to detail
• Proven strength in customer service skills
• MS Office skills
• Ability to prioritize workflow and work independently
• Experience with internal claims and provider database administration systems
• Ability to read, analyze and interpret general business periodicals, financial reports, legal documents, professional journals, technical procedures, or governmental dental regulations
• Ability to write reports, business correspondence and memos
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members in the business community
• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, and volume
• Ability to define problems, collect data, establish facts, and draw valid conclusions
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables

• Bachelor's Degree - related experience can substitute
• 2 years of related experience
• Or, equivalent military experience

• Knowledge of dental reimbursement methodology, dental plan designs and provider contracts
• Contracting experience
• Certification(s) may be desired
• Bi-lingual is preferred