Aetna Dental Network Liaison in Newark, New Jersey
Req ID: 55729BR
Network Liaison will be responsible for managing Aetna Dental Provider Networks and support efforts for all dental products in each assigned market to achieve business goals.
Serve as the Liaison with both the Primary Care and Specialist Dentists in a specific geographic territory.
Responsibilities will include the overall maintenance and territory management of the provider network; they will serve as a subject matter expert and demonstrate a strong understanding of Aetna's Dental Products and market position.
Liaison will negotiate contract language and provider compensation, review quality and service reports with the provider and appropriate staff, contact 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. Document resolution and follow through to all parties.
Must be able to present DHMO and PPO plan designs, compensation process, claim/encounter submission and referral policies during new office orientations and reorientations via the telephone.
Liaison must be able to demonstrate 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.
3-5 years experience in dental managed care environment dealing with dental providers.
Knowledge of dental terminology and CDT coding.
Contract and fee negotiation experience.
Some Dental office experience is helpful.
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
Functional - Network Management/Provider relations/1-3 Years
Functional - Network Management/Contract negotiation/1-3 Years
Functional - Network Management/Provider connectivity/1-3 Years
Functional - Products-Dental/DMO/1-3 Years
Functional - Products-Dental/PPO Dental/1-3 Years
Technical - Aetna Applications/Provider Contracts/1-3 Years/End User
Technical - Reporting Tools/Crystal Reports / Crystal Enterprise/1-3 Years/End User
Technical - EDI/EDI/1-3 Years/End User
General Business/Turning Data into Information/ADVANCED
Service/Handling Service Challenges/FOUNDATION
General Business/Demonstrating Business and Industry Acumen/ADVANCED
General Business/Maximizing Work Practices/ADVANCED
Leadership/Collaborating for Results/ADVANCED
This is a Full-Time Telework position, preferably in NJ, NY or PA. Training period in the office may be required.
ADDITIONAL JOB INFORMATION
If you have Integrity, Excellence in Service, Inspiration, Caring and a team player, then this job is for you! We are a great team with over a 100 years of experience at Aetna Dental.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care
Aetna 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 Veterans status.