Maryland Provider Partner Consultant, DentaQuest

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Job Description:

Candidates must reside in the state of Maryland. Preferably Garrett, Allegany, Washington, Frederick, Calvert, St. Mary's, Charles, or Eastern Shore counties.

The opportunity:  

The Provider Partner is the primary on site point person for providers to improve their understanding of our benefit programs, policies and procedures. The Provider Partner is responsible for provider networks with regard to office education, technology promotion, network recruitment (expansion and strengthening utilization), and onboarding of newly contracted providers. The Provider Partner is also responsible for administering on-site office reviews as required by network rules and regulations.

How you will contribute:  

• Analyze and monitor provider cost reports on an ongoing basis in order to educate and improve providers’ cost and quality performance.

• Maintain network participation by providing support to dentists and dental office managers to improve their understanding of all available benefit programs.

• Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication over the phone and email.

• Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.

• Negotiate special deals to maintain compliance and increase access in weak networks.

• Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.

• Facilitate Oral Health presentations to various educational institutions and organizations.

• Assist provider offices in filing their claims electronically.

• Serve as a partner with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary.

• Follow up with all termination letters submitted.

• Represent clients and company at trade shows, health fairs, audits, dental summits, etc. throughout the designated market.

• Maintain and submit all required reports.

• Assist in resolving elevated complaints and issues for clients, members and providers.

• Obtain letters of recommendation from providers.

• Develop complete understanding of the Office Reference Manuals.

• Develop and continually improve personalized presentations of company benefit programs

• Recruit participating and non-participating providers to higher level of participation for all applicable market LOBs.

• Manage CAP office performance

• Provide recommended solutions to market related issues.

• Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities.

• Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate.

• Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices.

• Resolve difficult claims issues in a timely manner by working with the appropriate internal resources to research and resolve such issues.

• Increase access for members by strengthening and expanding existing network.

• Help to maintain a secondary network.