Elite Dental Partners

  • Director of Payor Relations

    Job Locations US-IL-Chicago
    Posted Date 1 month ago(1 month ago)
    ID
    2017-1162
    # of Openings
    1
  • Overview

    We assist dental practices that are facing non-clinical challenges by providing them with industry proven non-clinical practice support services.

    Non-clinical support services include payor relations, group supplies purchasing, capital equipment procurement, staffing management, finance, marketing, and information systems management.

    Responsibilities

    The Director of Payor Relations is responsible for the development and implementation of Elite Dental Partners’ payor strategy for affiliated practices and network of healthcare providers.  This position focuses on strategic planning and management of fee schedule optimization, contract negotiations, network participation and relationship management in accordance with the organization’s strategic business plan. They will monitor the performance and viability of payor agreements, review and analyze provider reimbursements and participate in the negotiation and re-negotiation of payor agreements.

    Duties and Responsibilities:

    • Lead and develop pricing strategy and processes to manage changes in pricing
    • Manage UCR and payor fee schedules, including negotiations of fees with payor partners
    • Identify new payors that deliver profitable, incremental business; lead process to get affiliated providers in network with new payors
    • Lead efforts to improve search results of affiliated providers in payor search tools online
    • Responsible for fostering and maintaining positive and productive working relationships with all existing and future payors
    • Review and analyze all incoming and annual proposals from new and/or existing carriers. Communicate with the Senior Management team regarding the viability of the plan/fees
    • Monitors industry trends, anticipating implications and/or identifying opportunities and collaborating with Senior Management team to develop and manage strategic plans for contracting activities
    • Maintain all fee schedules and plan alerts in the practice management system. Ensure fee schedules remain current and accurate. Distribute all insurance and fee schedule updates to the dental practices
    • Ensure that company-wide insurance billings are maximized through negotiating fee schedules and applying proper contract & terms interpretation, subject to Senior Management approval
    • Review and analyze all fee schedule updates for errors and to ensure fees have not decreased. Present analysis to senior management for review
    • Maintain all insurance CDT procedure, explosion, and product codes in practice management system. Create promotional codes, as requested by Marketing
    • Maintain all NEA Payor ID’s in fee schedules and maintain all insurance companies in company internal database
    • Prepare annual review of UCR and compare fees to current NDAS
    • Manage and oversee insurance grievance and refunds functions
    • Advises management team of emerging trends and methodologies in the areas of managed care, payor relations, and legal issues
    • Conduct training for practices pertaining to Insurance matters, as requested. Create and distribute training materials to offices, as needed and updates occur.
    • Other duties and special projects as assigned.

    Qualifications

    • Bachelor’s degree in relevant field or experience consummate with education
    • 5+ years experience in working with insurance payors
    • Negotiation experience required
    • Ability to analyze and compare fees
    • Experience in multi-unit industries a plus

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