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Role Overview

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Under the supervision of the Plan Dental Director, the Manager Dental Programs is responsible for the daily operation of the dental plan by contributing to workflow development, training, monitoring and implementation. This position is also responsible for building and maintaining positive working relationships between AmeriHealth Caritas Family of Companies and its contracted dentists, vendors and fully delegated vendor networks. The Manager, Dental Programs performs or delegates performance of orientation sessions, educational visits and outreaches, and functions as a pro-active clinical liaison to increase access and adequate care for members in ACFC provider’s offices AND/OR through fully delegated vendor networks. This position will also coordinate resolution of provider issues; performs and remains knowledgeable in all workflow and timeliness requirements; and provides organizational leadership in the development and operational areas of the ACFC dental programs.

Work Arrangement:

•;;;;;;; This hybrid opportunity will require 4 days of in office work.

•;;;;;;; Travel will be required within Washington DC area.;

Responsibilities:

+ Fostering strong relationships with dental providers through regular communication and proactive engagement

+ Managing the onboarding process for new providers, including orientation and training in non-delegated states

+ Responding to provider inquiries, resolving issues, and addressing complaints related to claims, benefits, and other plan-related matters

+ ;Manage provider contracts, including reimbursement negotiations, in non-delegated states

+ Ensuring compliance with state and federal regulations

+ Assisting providers with claims processing, resolving complex claims issues, and ensuring timely payments

+ In non-delegated states, contributing to network expansion by recruiting new providers and maintaining existing relationships

+ Analyzing data to identify cost savings opportunities and other trends, and preparing reports as needed

+ ;Working cross-functionally to resolve provider issues, communicating effectively with all parties involved, and accessing and caring for members in our dynamic and innovative organization.

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Education/Experience:

+ Bachelor's degree required, Master's degree preferred

+ 3 to 5 years of experience in the healthcare or insurance industry

+ Certification as a Registered Dental Hygienist (RDH), or a Certified or Expanded Functions Dental Assistant (CDA or EFDA), is a plus

+ Strong communication and interpersonal skills

+ ;Excellent customer service skills

+ Knowledge of dental insurance and current dental terminology (CDT) codes

+ Familiarity with claims processing and provider enrollment

+ Problem-solving and analytical skills

+ Ability to work independently and as part of a team

+ Computer proficiency and knowledge of relevant software

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At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Our Comprehensive Benefits Package

The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the Washington D.C. area. Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training. AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more. The targeted hiring range for this role is expected to be between $100,000 and $136,200.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.