Regional Dental Network Operations Specialist-Hybrid, Upstate New York Region

Summary of Job

Participate in and drive activities related to the administration, monitoring, and oversight of the Commercial EmblemHealth Dental PPO Provider Networks. Ensure the integrity of the TruProvider provider file, compose, support and facilitate Credentialing compliance and protocols, and provide guidance for member and dental provider resolutions and grievance and appeal cases. Process the dental provider applications and perform quality assurance reviews for provider operations. Responsible for the recruitment of providers to grow EmblemHealth's dental network through consistent outreach, including daily phone calls and mailings. Quarterly in-person office visits to assigned territories, with the flexibility to support additional regions as business needs evolve will be assigned. Serve as interdepartmental liaison for project management; provide support to the department to ensure that projects and departmental objectives are achieved with a sense of urgency. Prepare recruitment materials and represent EmblemHealth at trade shows.

Responsibilities

• Recruit and expand the dental provider network through proactive outreach (calls, emails, mailings, fax, and in person office visits) to meet geo-access and sales support goals. Provider office visits which may require long-distance driving quarterly or as needed and may include up to or over 200 offices per quarter.
• Outreach via calls and mailings is conducted in accordance with internal service level agreements (SLAs).
• Develop and maintain provider relationships by addressing inquiries, resolving issues promptly, and supporting retention initiatives to ensure a positive provider experience.
• Monitor and maintain dental provider data accuracy in directories and applications; update information to ensure compliance and reliability for members and internal teams.
• Resolve dental provider grievances and appeals with urgency, ensuring compliance with regulatory standards and reinforcing provider trust.
• Support credentialing and quality assurance processes to maintain a high-quality, compliant dental network.
• Responsible for recruitment marketing efforts by preparing materials, attending trade shows, and representing the organization to attract new providers quarterly or as needed.
• Participate in special projects and audits and contribute to industry workgroups and conferences to support organizational goals and compliance.

Qualifications

• Bachelor's Degree
• Dental Hygiene License (Preferred)
• 3 - 5+ years of relevant, professional work experience (Required
• 2 - 3+ years of experience in a dental setting (Required)
• Knowledge of the health care industry and health care products (Required)
• Understanding of dental provider credentialing/contracting and dental claims systems (Required)
• Knowledge in dental insurance, dental claims system, provider relations, provider contracting, provider network development and contract negotiation and CAQH (Preferred)
• Familiarity with dental provider community (Required)
• Knowledge of dental network models, laws, and regulations (Required)
• Driver's license, reliable transportation, and willingness and ability to travel throughout NY state as required (Required)
• Strong communications skills (verbal, written, presentation, interpersonal) with all types/levels of audience (Required)
• Proficient with MS Office - Words, Excel, PowerPoint, Outlook, Teams, etc. (Required)

Additional Information

• Requisition ID: 1000003162
• Hiring Range: $56,160-$99,360