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Job Information

CVS Health Dental Network Liaison in Chicago, Illinois

Job Description

This role is work from home.

The required hours are Monday- Friday 8am-5pm CST.

Act as a primary resource for all dental products (DHMO and PPO) for providers, sales and marketing, and Dental Service Centers to aid in the achievement of Aetna Key Performance Measures.

Fundamental Components

  • 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 companies goals and targets, promote all EDI initiatives Special Ad Hoc Project as assigned

Background Experience

  • 3+ years experience in managed care environment dealing with either dental or medical providers is required

  • Prior dental office experience is preferred

  • Preferred BA Degree, High School diploma mandatory

Additional Job Information

Customer focused.Knowledge of dental DMO and PPO products preferred.Strong verbal and written communication skills.Negotiation skills.

Education

Bachelor's degree or equivalent experience

Percent of Travel Required

10 - 25%

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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