Job Brief

Qualified candidates must be able to visit providers' offices within a 2 hour radius of New Castle, DE.

Responsibilities:

The Dental Account Executive is responsible for building, nurturing and maintaining positive working relationships between Plans and its’ contracted or subcontracted fully delegated vendor providers for all dental connected products, including: Medicaid, and Medicare for the benefit of the membership. The Dental Account Executive is also the point person responsible for working with provider, delegated provider, vendor, and members for the goal of increasing covered utilization of the plans by the membership. The Dental Account Executive makes education visits in person and virtually, facilitates local outreach sessions, functions as a pro-active plan account leader and coordinates resolution of member and provider issues with internal partners and with the vendor.

• Functions as a liaison between Plans and the participating AHC providers by responding to their needs and inquiries, and educating providers and their office staff and/or suggesting such activities by vendors when dealing with a fully delegated network
• Functions as an account leader for assigned providers and manage the needs of the dental office when in an AHC network as well as through the vendor in a delegated market.
• Work directly with the vendor to ensure provider data accuracy, appropriate claims processing guidelines are applied,
• Collaborates to resolve system issues, understand and utilize the vendors systems and reporting capabilities.
• Advocate for members to gain access and covered care by plan at AHC providers or through fully delegated network providers.
• Serves as a back up to the Dental Program Manager as needed for Plan representation
• Works closely with the Medical Account Executive to manage the FQHC dental sites in AHC territories.
• Supports the Quality Management Department with the credentialing and re-credentialing process, and the investigation of member complaints.
• Works with all departments to develop and execute strategies for optimally managing medical costs.
• Assist with achievement of quality and health plan objectives through accomplishment of provider initiatives.
• Maintains knowledge of Plan policies and procedures related to provider contracting, provider credentialing, provider billing and payment, physician and hospital incentive programs, Plan provider file database requirements, and other key State and Federal regulatory requirements relating to providers. Maintains proficiency in Plan claim adjudication system.

Education/Experience:

• Qualified candidates must be able to visit providers' offices within a 2 hour radius of New Castle, DE (based on business need).
• Bachelor’s Degree or equivalent combination or education and work experience.
• Minimum of 3 years in the managed care/health insurance industry.
• 1-2 years Medicaid experience preferred.
• Minimum of 1 year in a Provider Services position.
• Previous experience working with providers.
• Previous provider relations experience preferred.
• Valid driver’s license and current auto insurance.
• Travel MAY BE required. Depending on assignment/Plan, this travel could be extensive and take more than 8 hours per day).

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