Provider Relations Representative, Oral Health

• Oversee the dental care network managed by the delegated entity, ensuring compliance with contractual obligations and performance standards. 
• Monitor and report on key metrics such as access, utilization, quality measures, and member satisfaction. 
• Conduct regular reviews of delegated entity operations to ensure adherence to Umpqua Health policies and regulatory requirements. 
• Ensure delegated entity meets all contractual requirements, including reporting, credentialing, and quality benchmarks. 
• Collaborate with internal teams to address gaps in performance and implement corrective action plans when necessary. 
• Maintain accurate documentation of oversight activities and prepare reports for leadership and regulatory agencies. 
• Serve as a resource for oral health providers within the network, addressing inquiries and resolving issues related to claims, credentialing, and operational processes. 
• Deliver training and education to providers on Umpqua Health initiatives, compliance standards, and oral health program requirements. 
• Assist in the development and implementation of oral health programs aimed at improving preventive care, member engagement, and overall health outcomes. 
• Support initiatives that integrate oral health with primary care and behavioral health services. 
• Partner with internal departments such as Compliance, Quality, and Network Development to ensure alignment of oral health strategies with organizational goals. 
• Participate in meetings with delegated entity leadership to review performance and discuss improvement opportunities. 

• Working with a variety of personalities, maintaining a consistent and fair communication style.
• Satisfying the needs of a fast-paced and challenging company.

• Bachelor's degree in healthcare administration, Business, Public Health, Communications, or a related field  
• Minimum of 3 years of experience as a Provider Relations Representative, Network Manager, or similar role within a Medicaid MCO or dental benefits administrator  
• Minimum of 5 years of hands-on experience working with dental providers (e.g., solo practices, group practices, or clinics serving Medicaid populations), including dental practice management, multi-site operations, or provider outreach  
• Strong knowledge of Medicaid Managed Care principles, including provider contracting, dental claims and billing processes (CDT codes), prior authorization, and regulatory compliance standards (e.g., NCQA, HEDIS, Dental Quality Alliance measures)  
• Familiarity with Oregon’s Coordinated Care Organization (CCO) model and Oregon Health Plan (OHP) dental benefits  
• Proven ability to conduct provider education, training sessions, site visits, and resolve issues such as claims disputes, policy questions, and billing support  
• Strong communication and relationship-building skills  
• Strong analytical and problem-solving abilities, including monitoring performance metrics and compliance  
• Proficiency in Microsoft Office Suite and ability to learn provider systems  
• Ability to manage multiple priorities, work independently, and meet deadlines in a field-based environment  
• Ability to interpret and enforce contractual requirements and regulatory standards  
• Ability to collaborate effectively with internal teams and external partners  
• Able to travel on-site

PREFERRED QUALIFICATIONS

• Dental-related certifications  
• Medicaid-specific training  
• Experience with value-based care models for oral health  
• Experience with delegated network oversight  
• Experience supporting oral health integration initiatives (e.g., prenatal or pediatric coordination)  
• Demonstrated experience working with diverse and rural provider populations 

• Salary is dependent on skills, experience, and education
• Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
• Medical, dental, and vision insurance
• 401(k) with company match (fully vested immediately)
• Company-sponsored life insurance and additional benefits
• Fitness reimbursement program
• Tuition reimbursement and more

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