Liberty Dental Plan

• Assist in recruiting General Dentists and Specialists to support network growth and meet access standards. • Analyze network needs and identify gaps requiring additional provider recruitment. • Manage and service provider relationships within assigned territory. • Conduct service calls and site visits to ensure provider satisfaction and address concerns. • Collect, review, and process provider contract documents for accuracy and completeness. • Ensure compliance with annual attestation requirements and internal policies. • Partner with internal teams and provider offices to resolve provider and member issues. • Educate providers on policies, procedures, and network requirements.

• Coordinate the client reporting process, partnering with internal teams to ensure accuracy, timeliness, and alignment with client expectations. • Identify and help resolve discrepancies in reporting, escalating complex issues as needed. • Act as a liaison between Client Services and internal departments to facilitate communication and follow-through. • Assist with client-related deliverables, including fulfilling requests and supporting Account Executives and Sales Coordinators. • Maintain accurate and organized client account documentation, including reporting schedules and trackers. • Ensure consistency and accessibility of operational records. • Proactively identify and resolve routine operational issues. • Contribute to process improvements by streamlining workflows, enhancing communication, and increasing efficiency. • Support the development and refinement of procedures and documentation.

• Manage scheduling, document preparation, and logistical coordination for Market Operations deliverables. • Provide ad hoc administrative support to managers and analysts. • Route requests and coordinate follow-ups between Market Operations and internal departments. • Prepare and format client-facing materials including meeting agendas, summaries, presentations, and reports. • Maintain accurate and organized documentation for contracts, renewals, trackers, and templates. • Monitor project timelines, deliverables, and issue tracking to support on-time completion. • Track key milestones and provide reminders and follow-ups as needed. • Identify gaps in administrative processes and recommend improvements.

• Perform timely clinical adjudication of dental claims and prior authorization requests • Determine medical necessity and benefit coverage using clinical expertise and plan guidelines • Interpret radiographs, charts, and supporting documentation to inform decisions • Identify inappropriate, unnecessary, or low-value services • Participate in quality improvement initiatives, audits, and utilization analyses • Conduct focused chart reviews to identify utilization trends and potential quality concerns • Support SIU activities, including provider site reviews and corrective recommendations • Analyze treatment patterns and recommend improvements • Conduct peer-to-peer consultations with network providers • Participate in grievance, appeal, and secondary review processes • Collaborate with specialists or subject-matter experts as needed • Participate in calibration sessions, trainings, and interrater reliability activities • Attend clinical and operational meetings • Contribute to credentialing and quality committees • Provide clinical input during tele-dentistry consultations when needed • Maintain expertise in dental benefit plans and Medicaid program requirements • Support regulatory reporting and compliance initiatives