Provider Representative
| Company | Delta Dental |
|---|---|
| Location | Nashville, TN, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Associate’s |
| Experience Level | Mid Level |
Requirements
- Associate’s degree in business administration, communications, dental assisting or dental hygiene
- Four years of experience in a position requiring knowledge of dental terminology, dental procedure codes, or dental office billing and record keeping practices within a provider office
- Experience administering dental benefit contracts within the insurance industry or identifying, analyzing, and resolving compliance issues based on policies and procedures outside of the insurance industry
- 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
- Position requires travel of 10-25% throughout the state of Tennessee, and nationally as necessary.
Responsibilities
- Supports providers with non-billing related issues, including education and outreach to those who do not routinely provide preventive services, at the direction of the PCDH Coordinator
- Conducts annual office visits to all participating dental offices within assigned region
- Responsible for being completely familiar with the operation of all State DBM Programs in respected region
- Educates and assists TennCare ECF CHOICES DBM Program and TennCare 1915© DBM Program including, but not limited to, management of adult dental benefits and benefit limits, Prior Authorization requests (including initial evaluation and treatment plan approval), electronic billing, compliance initiatives, and other program requirements as specified by TennCare
- Monitors and analyzes providers’ performance and compliance with organizational policies and standards
- Develops and maintains relationships with healthcare providers
- Collaborates with providers to address and resolve issues, as well as obtain documentation to support the claim process
- Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Preferred Qualifications
-
No preferred qualifications provided.