Provider Relations Representative - Mid-Missouri

Job Title: Provider Relations Representative - Mid-Missouri

Reports To: Provider Relations Network Manager 

FLSA Status: Exempt 

Grade Level: 24 

Last Updated: December 2024 

 

Position Summary: 

The primary responsibility of the Provider Relations Representative is expanding and enhancing the provider relations network in their assigned territory.  This position develops relationships with new providers, negotiates provider contracts and ensures ongoing connections with existing providers.  This includes educating providers on contractual obligations, new products and services, and policies and procedures. 

 

Responsibilities: 

Executes account management and services strategies to expand and retain the Provider network.  This work may include but is not limited to: 

• Developing ongoing relationships with Providers to ensure satisfaction, foster trust, and address any concerns or issues to enhance network retention; 

• Executing tailored strategies to effectively manage provider accounts, ensuring that they meet both the needs of the providers and the organization's objectives; 

• Assessing provider performance, ensuring adherence to contract terms, quality standards, and service levels, and provide support to optimize their participation and effectiveness; 

• Expanding the Provider network through ongoing relationship building and value sharing through in-person meetings, cold calling, networking and other lead generation strategies; 

• Conducting onsite dental reviews at Provider locations; 
• Maintaining network participation by providing support to providers and office managers to improve their understanding of all available benefit programs, processing polices and guidelines. 

Leads the negotiation and implementation of Provider contracts. This work may include but is not limited to: 

• Leading discussions and fee negotiations to get providers contracted into PPPO/Premier or Premier Exclusive networks; 

• Collaborating with internal departments to ensure that contracts meet regulatory standards and organizational policies, while aligning with provider expectations; 

• Validating new provider contracts ensuring correct ES and NPF data, and addressing any discrepancies in a timely manner; 

• Gathering reporting to support the practice and provider fee increase discussions; 

• Implementing new provider contracts, ensuring all operational, billing, and technical requirements are addressed and systems are updated accordingly. 

Serves as trusted advisor to the Providers and their team members on industry trend and best practices.  This work includes but is not limited to: 

• Sharing information regarding current and future products and services; 

• Understanding internal processes and timelines to set expectations and recommend best practices; 

• Influencing Providers based on subject matter expertise of the industry, plans and internal processes; 

• Asking key questions to understand outcomes needed and providing recommendations that convey expertise in best practices; 

• Researching industry best practices and leveraging knowledge when communicating with Providers, Delta Dental member companies, competitors and other sources; 

• Communicating guidelines, policies and processes in a manner that builds trust in the company’s relationship with the Provider; 

• Fostering relationships with through networking,  dental societies, dental associations, respective Missouri/South Carolina Dental Board, member companies and others in the dental field 

• Responding to grievances and complaints and works toward timely resolutions as requested.   

Coordinates educational opportunities and materials for Providers.  This work includes but is not limited to: 

• Ensuring Providers have current information on providing high quality dentistry in compliance with contractual obligations; 

• Organizing and communicating Provider education events and workshops; 

• Identifying and recommending topics for events and workshops; 

• Reaching out to Providers to promote events, workshops and highlight key materials; 

Serves as the liaison between the dental office and other team members to ensure network directory accuracy. 

• Identifying and introducing Providers to the appropriate resources to resolve issues; 

• Delegating Provider requests and claims issues to the appropriate resources; 

• Communicating trust and confidence in fellow team members; 

• Ensuring accuracy of the network directory and credentialing/recredentialing process; 

• Conveying outcomes, policies, guidelines and best practices to Providers. 

Regular and reliable attendance is required. 

Other duties and responsibilities may be assigned. 

 

Qualifications: 

• 3+ years’ dental or other healthcare related industry experience required.  Insurance industry and dental clinical experience preferred; 

• Knowledge and experience handling complex and escalated customer calls or issues; 

• Advanced problem-solving and decision-making abilities; 

• Exceptional verbal and written communication skills; 

• Detail-oriented with a commitment to accurate documentation; 

• Strong organizational skills and the ability to manage a large client portfolio; 

• Access and ability to operate a motor vehicle; 

• Travel required, including occasional outstate travel with overnight stays.  

 

Competencies: 

• Accountability 

• Client Portfolio Management 

• Communication 

• Conflict Resolution 

• Continuous Selling 

• Negotiation 

• Networking 

• Perseverance 

 

Environment: 

This position currently functions as a hybrid role working from both home and in-office environments.  Any home office setting must be conducive to all guidelines outlined by the organization.  This role is required to regularly attend in-person meetings, the frequency of which is determined by management based on departmental or organizational needs.   

Physical and Other Demands: 

Specific vision abilities required by this job include the ability to adjust focus.  While performing the duties of this job, the employee is regularly required to sit, talk and hear.  The employee is frequently required to use hands and arms to handle, feel, reach and operate a computer.  This job requires substantial typing. 

DDMO provides reasonable accommodation to qualified individuals with a known disability unless doing so imposes an undue hardship.   

 

Employees must be able to successfully perform the essential functions of this role with or without a reasonable accommodation. 

 

Disclaimer: 

This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties or responsibilities that will be required.  The organization reserves the right to modify this job description at any time; including assigning or reassigning job duties or deleting this position at any time.