Job Description
Medical Mutual employees must submit their applications through MySource. Note: This is a hybrid position based in Centerville, OH, requiring 5 days onsite for initial training, transitioning to a 3-day onsite schedule thereafter. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Superior Dental Care - Dental Network Specialist Job Summary: To support the development and enhancement of the company’s dental network, this position handles provider applications, assists with the credentialing process, assists with recruitment campaigns, and manages ongoing relationships with both individual providers and Dental Service Organizations (DSOs) providers, guided by knowledge of corporate acceptance, participation, and professional review procedures. Responsibilities: Works with Senior Dental Network Specialist(s) to support credentialing and the ongoing relationship management of both individual and Dental Service Organizations (DSO) providers. Utilizes various system platforms to maintain up-to-date provider and Dental Service Organization (DSO) records and financial information. Processes provider claim pends and manages internal and external provider inquiries and submissions (such as those related to recruiting campaigns, contracting, and fee schedules) in a timely manner through multiple communication channels. Assists with technical support, provider registration, secure provider portal access and provider file monitoring. In support of Medicare Advantage compliance, works with Senior Dental Network Specialist(s) to facilitate processing updates for excluded and precluded providers based on the Center for Medicare and Medicaid requirements. Assists Senior Dental Network Specialist(s) to ensure seamless support and effective teamwork. Performs other duties as assigned. Superior Dental Care - Senior Dental Network Specialist To support the development and enhancement of the company’s dental network, this position independently handles provider applications, completes the credentialing process, participates in recruitment campaigns, and manages ongoing relationships with both individual providers and Dental Service Organizations (DSOs) providers, guided by knowledge of corporate acceptance, participation, and professional review procedures. Responsibilities: Responsible for credentialling and ongoing relationship management of both individual and Dental Service Organizations (DSO) providers. This involves making decisions regarding applications for network participation and working with a credentialing committee to report, assess, and present more complex cases. Utilizes various system platforms to maintain up-to-date provider and Dental Service Organization (DSO) records and financial information. Processes provider claim pends and manages internal and external provider inquiries and submissions (such as those related to recruiting campaigns, contracting and fee schedules) in a timely manner through multiple communication channels. Offers technical support and manages provider registration and secure access to the provider portal. Monitors all network provider file loads, addressing resulting errors timely and efficiently. In support of Medicare Advantage compliance, coordinate the excluded and precluded provider updates based on the Center for Medicare and Medicaid requirements. Orients, trains, and assists Dental Network Specialist(s), sharing tasks and responsibilities through cross-training to ensure seamless support and effective teamwork. Performs other duties as assigned. Qualifications: Superior Dental Care - Dental Network Specialist Associate degree in business or healthcare administration, communications or related field. Equivalent education and experience directly related to the role may substitute for a degree. 2 years of experience associated with provider network credentialling or equivalent customer service experience, preferably in dental insurance, dental providers office, or the healthcare/health insurance industry. Intermediate MS Office skills. Knowledge of provider contracts, network arrangements and fee schedule structures. Knowledge of standard customer service best practices and principles. Kn