Dental Account Executive

Summary

AmeriHealth Caritas is a health care solutions organization focused on helping people access care and build healthier communities. The Dental Account Executive manages relationships with dental providers, delegated vendors, and members, supports covered care utilization, coordinates issue resolution, and advances provider, quality, and health plan objectives in Pennsylvania.

Responsibilities

• Functions as a liaison between Plans and the participating AHC providers by responding to their needs and inquiries, educating providers and their office staff, and/or suggesting such activities by vendors when dealing with a fully delegated network
• Functions as an account leader for assigned providers and manages the dental office's needs in an AHC network and through the vendor in a delegated market
• Work directly with the vendor to ensure provider data accuracy and apply appropriate claims processing guidelines
• Collaborates to resolve system issues and understand and utilize the vendor's systems and reporting capabilities
• Advocate for members to access covered care by plan at AHC providers or through fully delegated network providers
• Serves as a backup to the Dental Program Manager as needed for Plan representation
• Works closely with the Medical Account Executive to manage the FQHC dental sites in AHC territories
• Supports the Quality Management Department with the credentialing and re-credentialing process and the investigation of member complaints
• Works with all departments to develop and execute strategies for optimally managing medical costs
• Assist with achieving quality and health plan objectives through accomplishing provider initiatives
• Maintains knowledge of Plan policies and procedures related to provider contracting, credentialing, provider billing and payment, physician and hospital incentive programs, Plan provider file database requirements, and other key State and Federal regulatory requirements relating to providers. Maintains proficiency in the Plan claim adjudication system

Skills

• • Bachelor's Degree or equivalent combination of education and work experience
• • Minimum of 1 year in an administrative Dental Provider Services position
• • Previous experience working with dental/healthcare providers
• • Valid driver's license and current auto insurance
• • Proficiency with MS Excel to include pivot table, Vlookup function, match function
• • Data analytics, eye for detail
• • Strong written and verbal communication skills
• • Minimum of 3 years in the managed care/health insurance industry preferred
• • Minimum of 1 year Medicaid experience preferred
• • Previous dental provider relations experience preferred

Qualifications

Must Haves

• • Bachelor's Degree or equivalent combination of education and work experience
• • Minimum of 1 year in an administrative Dental Provider Services position
• • Previous experience working with dental/healthcare providers
• • Valid driver's license and current auto insurance
• • Proficiency with MS Excel to include pivot table, Vlookup function, match function
• • Data analytics, eye for detail
• • Strong written and verbal communication skills

Nice to Haves

• • Minimum of 3 years in the managed care/health insurance industry preferred
• • Minimum of 1 year Medicaid experience preferred
• • Previous dental provider relations experience preferred

Benefits

• Flexible work solutions including remote options and hybrid work schedules
• Paid time off including holidays and volunteer events
• Health insurance coverage for you and your dependents on Day 1
• 401(k)
• Tuition reimbursement
• For fully remote associates residing in states where service is required by contract, law, or regulation, reimbursement for reliable high-speed internet service