Provider Representative

Job Title:

Provider Representative

Number of Positions:

1

Location:

DDMI - Nashville

Location Specifics:

Hybrid Position

Job Summary:

Must reside in Metropolitan Davidson County, Tennessee or a county contiguous to Metropolitan Davidson County, Tennessee.

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description:

Educates and assists participating dental providers in working with all state DBM Programs, including, but not limited to, management of TennCare ECF CHOICES DBM Program benefits, TennCare 1915© DBM Program benefit limits, CoverKids DBM Program benefits and benefit limits, and TennCare Adult Dental DBM Program benefits.  

Primary Responsibilities:

• Supports providers with non-billing related issues, including education and outreach to those who do not routinely provide preventive services, at the direction of the PCDH Coordinator.

• Conducts annual office visits to all participating dental offices within assigned region.

• Responsible for being completely familiar with the operation of all State DBM Programs in respected region.

• Educates and assists TennCare ECF CHOICES DBM Program and TennCare 1915© DBM Program including, but not limited to, management of adult dental benefits and benefit limits, Prior Authorization requests (including initial evaluation and treatment plan approval), electronic billing, compliance initiatives, and other program requirements as specified by TennCare.

• Monitors and analyzes providers’ performance and compliance with organizational policies and standards.

• Develops and maintains relationships with healthcare providers.

• Collaborates with providers to address and resolve issues, as well as obtain documentation to support the claim process.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

#LI-Hybrid

Minimum Requirements:

Position requires an associate’s degree in business administration,  communications, dental assisting or dental hygiene and four years of experience in a position requiring knowledge of dental terminology, dental procedure codes, or dental office billing and record keeping practices within a provider office, administering dental benefit contracts within the insurance industry, or identifying, analyzing, and resolving compliance issues based on policies and procedures outside of the insurance industry. Will accept any suitable combination of education, training, or experience.

Position requires Strong communication and interpersonal skills to effectively interact with healthcare providers and internal teams. Ability to manage multiple tasks and prioritize effectively. Knowledge of healthcare regulations and standards is a plus.

Must be physically located within the state of Tennessee Position requires travel of 10-25% throughout the state of Tennessee, and nationally as necessary.

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.