Manager Dental Professional Relations

Job Title

Manager Dental Professional Relations

Duration

Open until filled

Work Hybrid

Yes

Description

Let’s do great things, togetherAbout ModaFounded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.Position SummaryOversees the development of, maintenance of, and communication with all dental networks in Oregon and Alaska. Is responsible for programming for contracted dental providers. Supervises modifications in the filed fee system for all lines of business. Responsible for the contact correspondence. Maintains network statistics and monitors recruitment and retention efforts in Oregon and Alaska. Oversees provider recruitment, training and utilization of the Health through Oral Wellness Program. Ensures federal and state network compliance requirements are met.This is a hybrid position based in Portland Oregon. ​​Pay Range$74,334.50 - $92,936.38 annually, DOE. Please fill out an application on our company page, linked below, to be considered for this position

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Benefits:

• Medical, Dental, Vision, Pharmacy, Life, & Disability

• 401K- Matching

• FSA

• Employee Assistance Program

• PTO and Company Paid Holidays

Required Skills, Experience, & Education:

• High School diploma or equivalent.

• 1 – 2 years’ experience in Professional Relations preferably as a PR Specialist or related field.

• 1 – 2 years’ dental claims processing or dental customer service experience.

• Strong verbal, written, and interpersonal communication skills.

• Possess analytical, problem solving and detail orientation skills.

• PC proficiency with Microsoft Office applications.

• Ability to work well under pressure, work with frequent interruptions, and shifting priorities.

• Ability to come into work on time and on a daily basis.

• Maintain confidentiality and project a professional business image.

Primary Functions:

• Oversees fee schedule uploads to the filed fee system and NPF database.

• Oversees implementation of Delta Dental of Oregon and Alaska provider contracting.

• Monitors provider information uploads and troubleshoots NPF and Facets data inconsistencies.

• Monitors the dental credentialing process for Premier and PPO providers.

• Oversees Medicaid encounter data errors and DMAP provider enrollment.

• Manages our commercial dental (Premier and PPO) and Medicare Advantage networks, and other relationships necessary for the expansion of our dental products.

• Oversees department processes for CMS and state compliance requirements as related to dental.

• Acts as a liaison with Dental Claims, Dental Customer Service, Credentialing, Actuarial, Benefit Programming and Accounting departments so that problems can be solved along with system adjustment accommodations.

• Collaborates with the sales, underwriting, actuarial and product teams on dental product planning and development.

• Oversees provider contact correspondence and assists in resolving concerns directly with providers.

• Responsible for daily employee supervision, including mentoring, coaching, and attendance maintenance.

• Coordinates workflow for the Dental Professional Relations Department, including the assignments of tasks/projects and monitoring the completion of work and all DPR related claims queues.

• Represents Dental Professional Relations Department for company meetings, both internally and externally at functions such as trade shows, association meetings and provider workshops.

• Oversees the planning and scheduling of dental office visits for recruitment and retention and provider workshops.

• Works with staff on internal programs and issues, including directories.

• Coordinates and plans proactive provider communication through various channels (Dental Office Update (DOU), website, workshops, etc.) to introduce new policies, explains existing policies and request feedback for process improvement in conducting our business with provider offices.

• Maintains provider handbook by working with multiple internal departments on content review and revisions.

• Assists Sales, Account Services, and Compliance with network and dental programs related RFP responses and account renewals.

• Reviews dental marketing material to ensure all provider and network reporting is accurate.

• Conducts all UAT and system testing for the department.

• Creates Moda’s annual quality review outlining Dental PR’s projects and initiatives.

• Oversees the operation and reporting for The Childrens Program

• Manages provider recruitment, utilization, reporting, communication and marketing content for the Health through Oral Wellness program.

• Creates and manages annual department budget.

• Assists with appropriate dental queues/claims and credentialing projects.

• Other duties as assigned.

  ​​​​​​Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.