MCNA Dental, a leading dental benefits management company is seeking a Provider Relations Representative. The candidate will be responsible for maintaining working relationships with the existing Provider Network. Provides training and education regarding policy and procedures and covered benefits. Provides ongoing support for any issues. May assist with Network Development as needed.
- Assists in the implementation of the Provider Relations Department processes, provider education program s and overall network functions.
- Works with the management team to develop and revise the Provider Manual. Assists in ensuring that the manual meets operational, regulatory, and accreditation requirements.
- Carries out the site review process (for credentialing and re-credentialing), provider manual documentation for education and training, referral and authorization procedures, and department activities.
- Serves as a mode of communication to provider offices.
- Assists in meeting organizational goals and objectives.
- Acts as the liaison between the provider groups and the plan.
- Carries out methods of communication to the providers for changes, revisions, issue resolution, and general notices/updates from the plan.
- Attends Provider Relations meetings to determine network access and availability, and meeting the requirements for ongoing membership needs.
- Assists with network publication, reports, updates, revision, analysis, and reporting to appropriate internal staff and the Dental Management Committee.
- Provides provider training and education manual and processes, documentation, reviews.
- Other plan required duties and responsibilities as deemed necessary and appropriate.