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Position Summary
This position is part of our Dental Network DMO Recruitment team whose primary focus will be responsible for growing the DHMO Managed Care network nationally via phone and document in Salesforce. Key responsibilities is to Recruiter dentists to join our DHMO network, negotiate fees and contracts, support internal and external partners, provider credentialing, travel as needed, support sales initiatives, and evaluate the network deficiencies to ensure access to care needs are met. Strong knowledge of the DHMO product and markets are crucial to the role. Must be able to sell and influence providers to join the DHMO network. Act as a primary resource for all dental products (DHMO, PPO, Medicare) for providers, sales and marketing, and Dental Service Centers to aid in the achievement of Aetna Key Performance Measures. Act as the liaison with the Primary Care Dentists and Specialists in a specific geographic territory responsible for overall maintenance and territory management of the provider network, as a functional subject matter expert, demonstrating a strong understanding of Aetna's Dental Products and market position. Negotiation of contract language and provider compensation. Review quality and service reports with provider and appropriate staff, contacting Dental providers regarding quality reviews conducted where unacceptable results were obtained. Timely response to correspondence from Provider offices, included, but not limited to termination requests, tax id changes, hold requests, claim reimbursement, system, directory accuracy and various contractual issues. Documented resolution and follow through communicated to all parties. Presentation of DHMO and PPO plan design, compensation process, claim / encounter submission, and referral policies during new office orientations and reorientations via the telephone Knowledge of the competitive market and Aetna's relevant competitive position, to include member appointment access Presentation of Aetna's electronic capabilities for dental providers to achieve Company goals and targets, promote all EDI initiatives.
Required Qualifications
- 1- 3 years experience building a DMO Managed Care Network nationally
- 1-3 years’ experience in Dental network provider relations experience
- Solid focus on fee analysis and negotiations
- Independent and self-motivated with a collaborative team focus
- Demonstrates clear and effective, concise, and appropriate written and verbal communication abilities.
- 1 – 3 years’ experience Recruitment of Non-Par offices
- Robust technical proficiency Microsoft Office (Excel, Outlook, Word, PowerPoint)
Preferred Qualifications
- Experience in the dental field and knowledge of PPO, DMO, and Medicare networks.
Education
Bachelor's degree or relevant experience
Pay Range
The Typical Pay Range For This Role Is
$46,988.00 - $102,000.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 10/31/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
