Payer Strategy Specialist

  • MB2 Dental Solutions
  • Carrollton, TX, USA
  • May 03, 2022
Front Desk/Office manager Full time

Job Description


Overview

MB2 Dental LogoExecute Payer Strategy mission to negotiate and maintain the best terms and compensation with dental carriers for MB2 Dental (MB2) affiliated offices. Primary responsibilities include growing dental plan revenue, serving as a key liaison between MB2 offices and the carriers, and supporting the offices, Credentialing and Central Business Office (CBO) with strategic advice and daily maintenance.



Responsibilities

  • Negotiating contracts and compensation, pursuing member assignments, prospecting and presenting new Plans to Operations, to optimize Plan revenue and explore new partnerships.
  • Conduct Payer Portfolio Reviews for individual offices upon request.
  • Conduct ‘deep dives’ for struggling offices and create a Payer strategy.
  • Serve as single point of contact with assigned national accounts and key liaison between MB2 and all regional carriers to resolve daily issues that arise.
  • Serve as subject matter expert/information resource on Payers for offices, Operations and CBO, including benefits, fees, supplemental payments and E&L’s.
  • Work closely with payers to ensure proper understanding of Payer guidelines, contractual terms, and claims processes.
  • Actively manage all assigned Payer relationships including, but not limited to, annual reviews, opportunities, reimbursements,
  • Partners with CBO and Credentialing colleagues to resolve improper reimbursement.
  • Coordinate with internal departments, insurance companies and Operations leadership to conduct research for payer related concerns and resolution.
  • Facilitate implementation of EDI, EFT, ERA, web portals, and delegated credentialing.
  • Coordinate office training on how to maximize PPO and DHMO plan participation.
  • Coordinate patient grievance resolution, as needed.
  • Perform other related duties, as assigned.

Qualifications

Communication Skills

  • Language: able to read, write and speak English fluently.
  • Oral: speaks clearly and persuasively; effectively presents information and responds to questions.
  • Written: independently writes professional business correspondence; presents numerical data effectively.
  • Presentation: effective presentation skills with the ability to present to small groups of people.
  • A positive attitude and desire to work in a team environment.

Organizational Skills

  • Time Management: ability to organize and prioritize workload.
  • Administrative Skills: detail oriented; pays close attention to accuracy.
  • Strong follow-up skills

Computer Skills

  • Computer literate.
  • Software: working knowledge of Microsoft Office including Outlook, Word, and PowerPoint.
  • Software: advanced knowledge of Microsoft Excel, including ability to create, manipulate, analyze and interpret spreadsheets.
  • Working knowledge of the Internet, Internet browsers, and search engines.

EDUCATION AND EXPERIENCE

  • Associates degree desired.
  • Dental industry experience preferred.
  • Two to five years of dental office and/or dental plan experience desirable.
  • Equivalent combination of education and experience.

TRAVEL REQUIREMENTS

  • Limited travel -- 10-15% of the time.
  • Minimal overnight travel required.

CERTIFICATES, LICENSES, REGISTRATIONS

· None

POTENTIAL NEXT POSITION(S)

· Manager of Payer Strategy

Apply Here: https://www.click2apply.net/E5KbW2iW4NZRwhY1eh6qVe



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