Payer Relations Manager

Overview:

We are a fast-paced company working hard to make our doctor partners' visions come to life. Unique individuals and ideas are always welcome here. If you are looking for an employer that supports you in reaching your maximum potential – you'll feel right at home.

As a Payer Relations Manager, you will negotiate and establish favorable terms and compensation agreements with dental payers on behalf of MB2 Dental (MB2) affiliated offices. Your key responsibilities will include enhancing participation in various dental plans to maximize benefits for these offices, effectively navigating rental networks to secure optimal arrangements, and serving as the primary contact between MB2 offices and dental payers. Additionally, you will provide strategic advice on payer relations to the offices, as well as to the Credentialing and Central Business Office teams, ensuring seamless operations and strong partnerships.

DUTIES AND RESPONSIBILITIES

• Optimize existing Payer participation by negotiating all contract terms and compensation -- and pursuing Plan membership – on a regular cadence.
• Review Payer Agreements to identify and negotiate language that minimizes risk to Providers.
• Understand direct versus indirect Payer relationships (network leases) and ramifications on reimbursement.
• Prospect new Payers Network offerings and present analysis of strengths and weaknesses to the offices for consideration.
• Analyze Payers with inferior fees and/or membership and present findings to offices for TERM consideration.
• Serve as primary MB2 contact with assigned (national) Payers to resolve high-impact issues.
• Serve as subject matter expert/information resource on assigned Payers for MB2 internal audiences, including understanding carrier guidelines, contractual terms, and claims processes.
• Actively manage assigned Payer relationships, including hosting regularly scheduled reviews to discuss opportunities for increased partnership and reimbursement.
• Support internal departments, such as RCO and Credentialing, to research and resolve Payer- related issues impacting multiple Practices.
• Support implementation of operational efficiencies, such as EDI, EFT, ERA, web portals and delegated credentialing.
• Coordinate patient grievance resolution with Compliance Department as needed.
• Monitor state and federal legislation that affects Payer products and reimbursement.
• Perform other related duties, as assigned.

COMPETENCIES AND SKILLS

To perform the job successfully, an individual should demonstrate the following competencies:

• Analytical Skills
  • Gather and analyze information skillfully with ability to create Action Plans.
  • Prospecting: able to identify viable growth opportunities through data collection and analysis.
  • Think strategically and communicate recommendations to senior management.
  • Project revenue streams, conduct post-launch profitability analysis, and draw conclusions with recommendations.
• Relationship Management Skills
  • Interpersonal Skills: able to develop productive business relationships inside and outside MB2 Dental.
  • Negotiation Skills: experienced negotiator, able to reach mutually beneficial agreements.
  • Able to interact effectively with senior management in a cross-functional manner.
  • Strong customer service attitude and skills.
• Communication Skills
  • Language: able to read, write, and speak English fluently.
  • Oral: speaks clearly and persuasively; effectively presents information.
  • Written: writes professional business correspondence; presents numerical data effectively.
  • Presentation: effective presentation skills with the ability to present to small groups of people.
  • Able to communicate (with Payers) in a firm, yet professional, manner.
  • Positive attitude and desire to work in a team environment.
• Organizational Skills
  • Initiative: self-motivated, requiring minimal supervision while working remotely.
  • Time Management: able to organize and prioritize workload and execute tasks in a timely manner.
  • Administrative Skills: detail oriented; pays close attention to accuracy.
  • Strong follow-up skills: persistent while maintaining professionalism.
• Computer Skills
  • Strong computer/PC skills.
• 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

• Bachelor’s degree is desirable.
• Understanding of all dental benefit models including FFS, Indemnity, PPO, EPO, DHMO, Discount, Medicaid, and Medicare Advantage structures.
• Understanding of rental / leased networks.
• 10 years dental industry experience required.
• Two to five years of dental provider experience required; dental plan experience a plus.
• Equivalent combination of education and experience considered.

TRAVEL REQUIREMENTS

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

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