Job Description
Dental Practice Specialist
Overview
The Dental Practice Specialist is a key liaison between the organization, its clients, and participating providers within the Professional Networks Department. This role focuses on building and maintaining strong provider relationships, conducting outreach, researching provider concerns, supporting special projects, and ensuring a seamless provider experience from onboarding through ongoing network participation.
This position manages, supervises, and coordinates provider network development, maintenance, and contracting, as well as provider credentialing and service issues. The Dental Practice Specialist also represents the organization at external events, including major dental conferences and other industry forums.
Primary Responsibilities
- Serve as the main point of contact for providers, ensuring timely and professional communication.
- Develop and maintain strong relationships with practitioners participating in the dental network.
- Assist leadership in identifying growth areas and creating recruitment plans, including mailings, phone campaigns, and follow-ups to secure office contracts.
- Recruit prospective participating dentists to meet network adequacy requirements and sponsor/client-specific needs, focusing on key geographic markets.
- Develop and implement plans to enhance the provider experience and achieve key performance indicators (KPIs).
- Execute recruitment efforts independently using direct mail, phone calls, email outreach, and in-person visits to dental offices (travel required).
- Manage contracting, credentialing, and enrollment processes for participating providers, ensuring accuracy and compliance.
- Educate providers and office staff on program policies and procedures, including billing, claims submission, enrollment protocols, CDT codes, benefit limitations/exclusions, documentation requirements, payment practices, and provider portal navigation.
- Identify challenges and opportunities within the network proactively and implement solutions to drive positive outcomes.
- Champion continuous improvement efforts to enhance service and provider satisfaction.
- Respond to inbound calls, emails, and faxes from providers, office staff, and plan sponsors promptly and professionally; document all interactions in CRM and internal systems.
- Maintain accurate provider files (paper and electronic) and update information within internal systems.
- Assist in resolving provider complaints or service issues, including research, follow-up, and documentation.
- Collaborate with internal departments such as Claims, Customer Service, Compliance, and Member Services to resolve provider concerns.
- Interact with member services and community engagement teams to support provider-related solutions.
- Handle escalated provider office calls from internal staff and recommend corrective actions.
- Develop and maintain internal and external-facing provider network reports and dashboards.
- Participate in departmental and cross-functional projects or initiatives as assigned.
- Collaborate with internal business areas to improve efficiency, productivity, and service delivery.
- Provide regular feedback to management on recruitment trends and challenges to refine strategies.
- Recommend process improvements to streamline workflows.
- Contribute to a positive, solutions-focused team environment.
- Attend industry conferences and external events to represent the organization professionally.
- Perform other duties as assigned to support departmental and organizational goals.
- Ability to travel to conduct office visits and attend events.
Required Knowledge, Skills, and Abilities
- Experience with provider credentialing, contracting, or enrollment within a healthcare or dental plan environment.
- Ability to explain complex policies and credentialing requirements clearly and professionally.
- Strong organizational skills with the ability to manage multiple workflows, deadlines, and data accuracy across systems.
- Excellent customer service skills and professional phone etiquette.
- Competency in CRM systems and standard office software (Excel, Outlook, Word, SharePoint).
- Familiarity with internal data systems is preferred.
- Strong written and verbal communication skills with the ability to convey information effectively to diverse stakeholders.
- Knowledge of CDT codes, dental terminology, and payer-provider dynamics.
- High attention to detail with a focus on regulatory compliance and provider satisfaction.
- Ability to work independently as well as collaboratively within cross-functional teams.
- Previous experience in a dental office, Medicaid program, or dental insurance plan preferred.
- Professional demeanor and presence in both day-to-day interactions and at external events.
- Familiarity with provider data management best practices.
- Other duties as assigned.