Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Regional Dental Network Operations Specialist - Hybrid
Summary of Job
Participate in and drive activities related to the administration, monitoring, and oversight of the Commercial EmblemHealth Dental PPO Provider Networks. Ensure the integrity of the TruProvider provider file, compose, support and facilitate Credentialing compliance and protocols, and provide guidance for member and dental provider resolutions and grievance and appeal cases. Process the dental provider applications and perform quality assurance reviews for provider operations. Responsible for the recruitment of providers to grow EmblemHealth’s dental network through consistent outreach, including daily phone calls and mailings. Quarterly in-person office visits to assigned territories, with the flexibility to support additional regions as business needs evolve will be assigned. Serve as interdepartmental liaison for project management; provide support to the department to ensure that projects and departmental objectives are achieved with a sense of urgency. Prepare recruitment materials and represent EmblemHealth at trade shows.
Responsibilities
- Recruit and expand the dental provider network through proactive outreach (calls, emails, mailings, fax, and in person office visits) to meet geo-access and sales support goals. Provider office visits which may require long-distance driving quarterly or as needed and may include up to or over 200 offices per quarter.
- Outreach via calls and mailings is conducted in accordance with internal service level agreements (SLAs).
- Develop and maintain provider relationships by addressing inquiries, resolving issues promptly, and supporting retention initiatives to ensure a positive provider experience.
- Monitor and maintain dental provider data accuracy in directories and applications; update information to ensure compliance and reliability for members and internal teams.
- Resolve dental provider grievances and appeals with urgency, ensuring compliance with regulatory standards and reinforcing provider trust.
- Support credentialing and quality assurance processes to maintain a high-quality, compliant dental network.
- Responsible for recruitment marketing efforts by preparing materials, attending trade shows, and representing the organization to attract new providers quarterly or as needed.
- Participate in special projects and audits and contribute to industry workgroups and conferences to support organizational goals and compliance.
Qualifications
- Bachelor’s Degree
- Dental Hygiene License (Preferred)
- 3 – 5+ years of relevant, professional work experience (Required
- 2 – 3+ years of experience in a dental setting (Required)
- Knowledge of the health care industry and health care products (Required)
- Understanding of dental provider credentialing/contracting and dental claims systems (Required)
- Knowledge in dental insurance, dental claims system, provider relations, provider contracting, provider network development and contract negotiation and CAQH (Preferred)
- Familiarity with dental provider community (Required)
- Knowledge of dental network models, laws, and regulations (Required)
- Driver’s license, reliable transportation, and willingness and ability to travel throughout NY state as required (Required)
- Strong communications skills (verbal, written, presentation, interpersonal) with all types/levels of audience (Required)
- Proficient with MS Office - Words, Excel, PowerPoint, Outlook, Teams, etc. (Required)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.