Translator, Cantonese
Cayuse Holdings
Provider Partner Consultant
Sun Life
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $63,000 - $94,500 per year
Job Level
Mid-LevelSenior
About the role
- Primary on site point person for providers to improve their understanding of benefit programs, policies and procedures
- Analyze and monitor provider cost reports to educate and improve cost and quality performance
- Maintain network participation by supporting dentists and dental office managers
- Educate providers on policies and procedures through office visits, phone and email
- Promote Web applications and increase electronic claims volume
- Negotiate special deals to maintain compliance and increase access
- Recommend changes to QA processes and internal methods
- Facilitate Oral Health presentations to educational institutions and organizations
- Assist provider offices in filing claims electronically
- Answer remittance, payment, benefit, claims, and eligibility questions
- Follow up with termination letters and maintain required reports
- Represent clients and company at trade shows, health fairs, audits, dental summits
- Assist in resolving elevated complaints and issues
- Obtain letters of recommendation from providers
- Recruit participating and non-participating providers to increase participation
- Manage CAP office performance
- Organize and present information to providers and staff
- Resolve difficult claims issues working with internal resources
- Strengthen and expand existing network to increase access
- Other duties as assigned
Requirements
- Must reside in MD- prefer Garrett, Allegany, Washington, Frederick, Calvert, St. Mary's, Charles, or Eastern Shore counties
- Bachelor’s Degree in Business, Healthcare Administration or related field (or relevant work experience)
- 3 years’ related work experience in healthcare environment
- Strong presentation skills
- Excellent verbal and written communication skills
- Ability to work independently and as part of a team
- Knowledge of Microsoft Office
- Proven problem-solving skills
- Up to 50% local travel required
- Problem solving and training experience
- Ability to make good judgment conclusions based on data available with minimal supervision
- Preferred: Dental knowledge with five (5) or more years of office experience
- Preferred: Managed Care experience
