Director Payor Relations
Overview
Coast Dental is a network of dental practices throughout California, Florida, Georgia, Nevada, and Texas providing high quality comprehensive dental care. We are now one the country's largest dental support organizations, and our continued growth is based on the contributions of our outstanding dental team members. If you are bright, dedicated and driven to succeed, we want to talk to you.
The Director, Payor Relations is responsible for the strategic planning and management of Coast Dental contract negotiations, network participation, and
rel relationship management in accordance with the organization's strategic business plan. They will monitor performance and viability of payor agreements, review and analyze provider reimbursement, and participate in the negotiation and re-negotiation of payor agreements.
.
Duties and Responsibilities
INSURANCE CONTRACTS & NEGOTIATION
Responsible for fostering and maintaining positive and productive working relationships with all existing and future payers.
Ensures that the department is compliant with the Centers for Medicare and Medicaid Services requirements and other applicable laws and regulations.
Review and analyze all incoming and annual proposals from new and/or existing carriers. Communicate with the Senior Management team regarding the viability of the plan/fees.
Monitors industry trends, anticipating implications and/or identifying opportunities and collaborating with Senior Management team to develop and manage strategic plans for contracting activities.
Maintain all fee schedules and plan alerts in the practice management system. Ensure fee schedules remain current and accurate. Distribute all insurance and fee schedule updates to the dental practices.
Ensure that company-wide insurance billings are maximized through negotiating fee schedules and applying proper contract & terms interpretation, subject to Senior Management approval.
Review and analyze all fee schedule updates for errors and to ensure fees have not decreased. Present analysis to senior management for review.
Maintain all insurance CDT procedure, explosion, and product codes in practice management system. Create promotional codes, as requested by Marketing.
Maintain all NEA Payor ID's in fee schedules and maintain all insurance companies in company internal database.
Prepare annual review of Coast UCR and compare fees to current NDAS.
Manage and oversee insurance grievance and refunds functions.
Advises management team of emerging trends and methodologies in the areas of managed care, payer relations, and legal issues.
MISCELLANEOUS
Conduct training for practices pertaining to Insurance matters, as requested. Create and distribute training materials to offices, as needed and updates occur.
Other duties and special projects as assigned.
Qualifications
Knowledge, Skills and Abilities
Proficient in MS Outlook, Word and advanced in Excel.
Detailed experience with insurance company pricing, underwriting or medical/dental billing, coding, contracts and strong knowledge of fee schedules.
Ability to analyze data, interpret insurance contracts and focus on details.
Ability to effectively prioritize and execute tasks.
Ability to develop and implement process and procedures as needed.
Ability to handle sensitive information and maintain confidentiality.
Must be a self-starter with an excellent organization skills and detail-oriented.
Ability to manage a large team in a fast-paced environment.
Q Qualifications (Experience, Education, Licensure, Certification)
Bachelor's degree and/or equivalent experience.
Previous experience negotiating insurance contracts and fees. Ability to analyze and compare fees.
Experience with dental and physician reimbursement, including the skills necessary for detailed rate analysis.
Previous experience as an Insurance or Grievance Specialist in the dental industry strongly preferred.
Previous management experience preferred.
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
Coast Dental is a network of dental practices throughout California, Florida, Georgia, Nevada, and Texas providing high quality comprehensive dental care. We are now one the country's largest dental support organizations, and our continued growth is based on the contributions of our outstanding dental team members. If you are bright, dedicated and driven to succeed, we want to talk to you.
The Director, Payor Relations is responsible for the strategic planning and management of Coast Dental contract negotiations, network participation, and
rel relationship management in accordance with the organization's strategic business plan. They will monitor performance and viability of payor agreements, review and analyze provider reimbursement, and participate in the negotiation and re-negotiation of payor agreements.
.
Duties and Responsibilities
INSURANCE CONTRACTS & NEGOTIATION
Responsible for fostering and maintaining positive and productive working relationships with all existing and future payers.
Ensures that the department is compliant with the Centers for Medicare and Medicaid Services requirements and other applicable laws and regulations.
Review and analyze all incoming and annual proposals from new and/or existing carriers. Communicate with the Senior Management team regarding the viability of the plan/fees.
Monitors industry trends, anticipating implications and/or identifying opportunities and collaborating with Senior Management team to develop and manage strategic plans for contracting activities.
Maintain all fee schedules and plan alerts in the practice management system. Ensure fee schedules remain current and accurate. Distribute all insurance and fee schedule updates to the dental practices.
Ensure that company-wide insurance billings are maximized through negotiating fee schedules and applying proper contract & terms interpretation, subject to Senior Management approval.
Review and analyze all fee schedule updates for errors and to ensure fees have not decreased. Present analysis to senior management for review.
Maintain all insurance CDT procedure, explosion, and product codes in practice management system. Create promotional codes, as requested by Marketing.
Maintain all NEA Payor ID's in fee schedules and maintain all insurance companies in company internal database.
Prepare annual review of Coast UCR and compare fees to current NDAS.
Manage and oversee insurance grievance and refunds functions.
Advises management team of emerging trends and methodologies in the areas of managed care, payer relations, and legal issues.
MISCELLANEOUS
Conduct training for practices pertaining to Insurance matters, as requested. Create and distribute training materials to offices, as needed and updates occur.
Other duties and special projects as assigned.
Qualifications
Knowledge, Skills and Abilities
Proficient in MS Outlook, Word and advanced in Excel.
Detailed experience with insurance company pricing, underwriting or medical/dental billing, coding, contracts and strong knowledge of fee schedules.
Ability to analyze data, interpret insurance contracts and focus on details.
Ability to effectively prioritize and execute tasks.
Ability to develop and implement process and procedures as needed.
Ability to handle sensitive information and maintain confidentiality.
Must be a self-starter with an excellent organization skills and detail-oriented.
Ability to manage a large team in a fast-paced environment.
Q Qualifications (Experience, Education, Licensure, Certification)
Bachelor's degree and/or equivalent experience.
Previous experience negotiating insurance contracts and fees. Ability to analyze and compare fees.
Experience with dental and physician reimbursement, including the skills necessary for detailed rate analysis.
Previous experience as an Insurance or Grievance Specialist in the dental industry strongly preferred.
Previous management experience preferred.
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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