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Dental Medicaid Provider Network Specialist
- Job Title
- Dental Medicaid Provider Network Specialist
- Duration
- Open until filled
- Description
-
Let’s do great things, together!
About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.
Position Summary
The Dental Medicaid Provider Network Specialist collaborates with ODS management to recruit and retain dental Medicaid providers, ensuring sufficient access to dental care for members. This role also handles contract inquiries, onboarding of new providers, ongoing network support, and assistance to sub-capitated providers through training, meeting coordination, inquiry resolution, and assignment tracking, as well as supporting special projects related to provider network operations. This is a FT WFH role.Pay Range
$25.08 - $28.21 hourly (depending on experience)
**Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
Please fill out an application on our company page, linked below, to be considered for this position.
https://j.brt.mv/jb.do?reqGK=27755245&refresh=true
Benefits:
- Medical, Dental, Vision, Pharmacy, Life, & Disability
- 401K- Matching
- FSA
- Employee Assistance Program
- PTO and Company Paid Holidays
Required Skills, Experience & Education:- Bachelor’s degree in a healthcare-related field or equivalent experience.
- Minimum three (3) years of experience in a dental office or healthcare setting.
- Knowledge of dental terminology.
- Excellent verbal, written, and presentation skills, with the ability to organize and deliver information clearly.
- Proven ability to build and maintain positive provider and team relationships.
- Self-motivated with the ability to work independently and meet or exceed goals.
- Strong organizational skills with high attention to detail and ability to prioritize effectively.
- Proficiency with Microsoft Office applications.
- Typing speed of 35 wpm (net).
- Ability to work well under pressure, with frequent interruptions and shifting priorities.
- Collaborative team player.
- Ability to travel as needed; valid driver’s license required.
- Maintain confidentiality and adhere to corporate, state, and federal guidelines.
- Maintain a professional appearance, demeanor, and representation of Moda and ODS Community Dental in all internal and external interactions and events.
- Dependable attendance in both remote and in-office environments; some weekend work required.
Primary Functions:- Partner with the Dental Medicaid Manager to retain and expand the provider network through strategic recruitment.
- Follow up on contract opportunities, track provider data in CRM, and consult with the manager on the best contract options.
- Identify opportunities for provider education; develop and distribute materials.
- Develop proficiency in all dental contracting models (FFS, specialty agreements, capitation, risk-based agreements).
- Manage special projects related to Coordinated Care Organization (CCO) contract deliverables.
- Build relationships through phone and on-site outreach, providing follow-up support.
- Collaborate with data analysts to generate provider and member access reports.
- Document inquiries, cases, and communications in the CRM.
- Educate providers on OHP quality measures, compliance, and Oregon Administrative Rules (OARs).
- Respond to provider office inquiries and serve as liaison to resolve escalated claims issues.
- Develop understanding of the sub-capitated model, assisting with implementation, training, and support.
- Perform other duties as assigned by Dental Services management.
Working Conditions & Contact with Others
- Office environment with extensive close PC and keyboard use, constant sitting, and frequent phone communication. Must be able to navigate multiple computer screens. A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek, including evenings and occasional weekends, to meet business need. Minimal travel throughout state.
- Internally with dental Medicaid services, dental professional relations, dental customer service, chief dental officer, and other departments as needed. Externally with dental providers, provider office staff, and office administrators.
Together, we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training.
For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email.
