, California

Job Description
This role is work from home.The required hours are Monday- Friday 8am-5pm PST.

Act as a primary resource for all dental products (DHMO and PPO) for providers, sales and marketing, and Dental Service Centers to aid in the achievement of Aetna Key Performance Measures.
- Act as the liaison with the Primary Care Dentists and Specialists in a specific geographic territory responsible for overall maintenance and territory management of the provider network, as a functional subject matter expert, demonstrating a strong understanding of Aetna's Dental Products and market position.
- Negotiation of contract language and provider compensation
- Review quality and service reports with provider and appropriate staff, contacting- 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.
- Documented resolution and follow through communicated to all parties
- Presentation of DHMO and PPO plan design, compensation process, claim / encounter submission, and referral policies during new office orientations and reorientations via the telephone
- 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

Required Qualifications
- 3+ years experience in managed care environment dealing with either dental or medical providers is required

Preferred Qualifications
- Prior dental office experience is preferred
- Preferred BA Degree, High School diploma mandatory

Bachelor's degree or equivalent experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

, California

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses


"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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