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Provider Service Representative

Company: Delta Dental of Washington
Location: Spokane
Posted on: April 1, 2024

Job Description:

We are seeking a Provider Services Representative to be responsible for assisting providers and Delta Dental of Washington Member Dentists in network enrollment, completion of credentialing requirements, and maintaining accurate provider data.

This position is primary point of contact for dentists and dental offices for network enrollment and network service. As a liaison with providers and Provider Ambassador Representatives, meets partners needs and contributes towards achieving provider and corporate initiatives. Provides accurate and timely responses to all inquiries. This position is responsible to research and interpret complex provider issues and data, to resolution while striving to improve sentiment and overall experience.

At Delta Dental of Washington our vision is that all people can enjoy good oral and overall health, with no one left behind. We succeed because of a shared commitment to a set of values that guide everything we do - for our customers, for our communities, and for each other. We are Accountable. We lean in with Courage. We stay Curious. We are Inclusive. We act with Integrity.

We offer highly competitive medical, dental and vision plans as well offering a generous 401k match and all employees start accruing vacation and sick time from their very first day. We empower employee development through our tuition reimbursement plan, professional development plans, and employee-led communities.

The pay range for this position for Western Washington varies between $40,905.00 - $55,298.00, and for Eastern Washington varies between $39,520.00 - $51,465.00. Washington Dental Service and its affiliates, including Delta Dental of Washington and Arcora Foundation, intends to offer the selected candidate a base pay within this range, dependent on job-related, non-discriminatory factors such as experience. Base pay will also be adjusted based on the candidate's geographic location.

Essential Responsibilities include the following: The list of responsibilities listed is not intended to be comprehensive. Washington Dental Service and its affiliates, including Delta Dental of Washington andArcoraFoundation reserve the right to change the responsibilities at any time with or without notice.

  • Build and maintain provider relationships, improve provider/office experience and go above and beyond during interactions to make dental simple.
  • Serve as liaison with providers and Provider Ambassador Representatives to ensure providers/offices needs are met for data, claims, network, fee inquiries, and documents.
  • Coordinate intake and output as primary service and education to our partners in the areas of network enrollment, network contract terms, claims processing, processing policies, explanation and research on payments, and complaints.
  • Receive, review, respond and act on all service requests from other departments as well as dentists and dental office staff.
  • Approach every interaction to ensure DDWA has the most accurate information, provider's needs are heard and addressed, transactions are completed with all potential impacts reviewed and provide great customer service experience.
  • Outreach to providers/offices to attain missing documentation needed to complete provider adds, changes, terms, updates, and credentialing.
  • Partner and collaborate with other Deltas regarding provider issues.
  • Manage the Provider Service inbox and hotline.
  • Report on trends, questions, and inquiries along with recommendations for improving provider experience.
  • Assist Credentialing Team in obtaining documents when needed.
  • Assist Credentialing Team in source verification of required documentation for network enrollment, audit requirements, and minimum standards.
  • Monitor and service the Provider Service phone queue, listening to providers/offices, ensuring professional response, education and direction for all provider data related issues for DDWA and other Delta member companies during assigned phone shift.
  • Input, maintain, and update provider information in the provider and claim management systems including thorough and accurate provider correspondence and documentation as necessary.
  • Meet established turnaround requirements for each action and work type.
  • Grow provider networks through education, direction and referring to Provider Ambassadors.

    Experience, skills, and education do you need to have to succeed in the position: The requirements listed below are representative of the knowledge, skill, and/or ability required to successfully perform the essential functions of the position.

    • Proficient with PC, technologies and Microsoft Office Suite products.
    • Time management and work prioritization in fast paced production environment
    • Strong interpersonal skills and a flexible work style.
    • Reliable and collaborative work ethic.
    • Friendly and professional written and oral communication skills.
    • Detail oriented with consistent follow-up practices with focus on building sentiment and positive relationships
    • Critical thinking, research and interpretation of data.
    • Effectively manage varied tasks through organization, prioritization and collaboration.
    • Strong passion for delivering outstanding customer service.
    • Flexible, innovative and work in an ambiguous environment.
    • Build working relationships with all levels of the organization and across business units.
    • Two years of related experience providing quality customer service

      Washington Dental Service and its affiliates, including Delta Dental of Washington andArcoraFoundation is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

      Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

      The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: Delta Dental of Washington, Spokane , Provider Service Representative, Sales , Spokane, Washington

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