Denver Metro Provider Partner Consultant, DentaQuest

You are as unique as your background, experience and point of view. Here,
youll be encouraged, empowered and challenged to be your best self.
Youll work with dynamic colleagues – experts in their fields – who are
eager to share their knowledge with you. Your leaders will inspire and help
you reach your potential and soar to new heights. Every day, youll have
new and exciting opportunities to make life brighter for our Clients – who are
at the heart of everything we do. Discover how you can make a difference in
the lives of individuals, families and communities around the world.

DentaQuest manages dental and vision benefits for more than 33 million
Americans. Our outcomes-based, cost-effective solutions are designed for
Medicaid and CHIP, Medicare Advantage, small and large businesses, and
individuals. With a focus on prevention and value, we aim to make quality
care accessible to improve the oral health of all.

Job Description:
Location: Candidate must be located in the Denver Metro Area.

At Sun Life, we look for optimistic people who want to make life brighter
for ourClients.We understand the value of diverse cultures, perspectives,
and identities, and want you to bring your full and authentic self to
work.Every day,youll be empowered and challengedbyworking withdynamic
colleaguesto find new and innovative ways to make Sun Life the best benefits
company in America.

The opportunity:
The Provider Partner is the primary on site point person for providers to
improve their understanding of our benefit programs, policies and
procedures. The Provider Partner is responsible for provider networks with
regard to office education, technology promotion, network recruitment
(expansion and strengthening utilization), and onboarding of newly
contracted providers. The Provider Partner is also responsible for
administering on-site office reviews as required by network rules and
regulatio

How you will contribute:

Analyze and monitor provider cost reports on an ongoing basis in order to
educate and improve providers cost and quality performance.

Maintain network participation by providing support to dentists and dental
office managers to improve their understanding of all available benefit
programs.

Educate providers by instructing and advising of the comprehensive policies
and procedures involving all phases of the corporations benefits and
contracts through office visits and communication over the phone and email.

Promote dentist adoption of technology solutions by promoting Web applications
and increasing the volume of electronic claims.

Negotiate special deals to maintain compliance and increase access in weak
networks.

Seek continuous improvements by recommending changes in internal methods and
procedures to Quality Assurance process.

Facilitate Oral Health presentations to various educational institutions and
organizations.

Assist provider offices in filing their claims electronically.

Serve as a partner with dental offices by answering remittance, payment,
benefit, claims, and eligibility questions when necessary.

Follow up with all termination letters submitted.

Represent clients and company at trade shows, health fairs, audits,
dental summits, etc. throughout the designated market.

Maintain and submit all required reports.

Assist in resolving elevated complaints and issues for clients, members and
providers.

Obtain letters of recommendation from providers.

Develop complete understanding of the Office Reference Manuals.

Develop and continually improve personalized presentations of company benefit
programs

Recruit participating and non-participating providers to higher level of
participation for all applicable market LOBs.

Manage CAP office performance

Provide recommended solutions to market related issues.

Organize and present information to providers and their staff by speaking
before various provider organizations nd representing the corporation in
dental related activities.

Assist in problem resolution by… For full info follow application link.

Sun Life Financial is an equal employment and affirmative action employer. All
qualified applicants will receive consideration without regard to race,
color, sex, religion, age, national origin, disability, veteran
status, sexual orientation, gender identity or expression, marital
status, ancestry or citizenship status, genetic information, pregnancy