Company : United Concordia DentalJob Description : JOB SUMMARY ** MUST BE A US CITIZEN ** This job services United Concordia Dental's (UCD’s) clients by recruiting, training and servicing quality dental networks in assigned territory in a remote and mobile work environment. Manage network contracts including negotiations, contract development/renewal and financial reimbursement. Meet with dentists and office personnel to act as the intermediary between the organization and UCD. Respond to contractual and payment issues both internally and externally. Ensure compliance with contractual terms through regular on-site audits. Apply an active role in network management, training, monitoring and enforcement of company policies and procedures while increasing provider efficiencies. ESSENTIAL RESPONSIBILITIES - Identify and initiate contact with prospective providers. Develop and follow up on leads in an established time frame, while incorporating a sound business plan strategy to support and execute recruitment efforts that include existing and prospective client needs and provider resignations/terminations. Customize participating dental agreement forms for execution, analyze provider changes, facilitate provider file updates and draft confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees. - Analyze and develop network retention strategies for follow up services to providers by establishing and maintaining contact and rapport with dental staff members, office managers, insurance coordinators, hygienists and dentists throughout an assigned territory by scheduling face-to-face meetings with dental offices. Formally present and effectively communicate UCD's administrative and claim guidelines and policies, benefits of participation, fee schedules, plan designs, competitive position, product development, network options, strategic partnerships, utilization review, local/national client demographics and dentist distribution. Interpret and articulate contractual language and address questions regarding participation with providers, network share/leasing arrangements, opt in/out options, reimbursement methods, compensation models, including pay for performance and value added benefits. Meet with all identified practices in assigned territory to review practice financial and quality performance. - Perform effective on-site visits through educating providers on the financial advantages and marketing incentives of participation. Train dental office staff on the use of automated services to ensure they utilize various means of automated communication, as well as, claims and electronic data interchange and electronic funds transfer. Collaborate with sales and customer service to respond to client/broker/member inquiries regarding provider contract, claim/member issues or provider file/record/directory discrepancies. Consult with dental director/dental advisers regarding clinical-related questions and policies, as well as, current dental terminology (CDT) changes, to resolve provider inquiries within a mutually agreed timeframe. - Act as subject matter expert with recommendations and data supporting development of network and sales strategy and support of leasing contract negotiation. Develop and maintain leasing revenue targets. Update network lease risk strategy in response to all market changes. - Communicate and maintain effective working relationships both internally and externally (providers, dental industry, organized dentistry and dental consultants) keeping management informed on related healthcare industry issues/topics. Support competitive position in the marketplace by staying abreast of changes to the business climate. Monitor provider reimbursement methods and PPO/DHMO/EPO network models and communicate changes to provider community and leadership team. - Develop and manage process improvement initiatives designed to maintain URAC accreditation of all network practices associated with government programs using continuous quality improvement principles. Conduct, collect and analyze data from office site visits and reviews to continually improve the care and service to members and provide recommendations to internal customer supporting quality improvement programs. Train dental office staff and providers on all updates to quality assurance guidelines, with state and local regulations and URAC accreditation requirements. Conduct audits as needed. - Other duties as assigned or requested. EDUCATION Required - High School Diploma/GED Preferred - Bachelor's Degree - Business EXPERIENCE Required - 3 - 5 years of experience in the healthcare/insurance industry or professional experience in presenting concepts and influencing others in varying audiences Preferred - 3-5 years of experience as Dental in Dental Operations, Revenue Cycle Management, Payer Relations, Payer contracting and Payer strategy development; strong understanding of the DSO landscape LICENSES OR CERTIFICATIONS Required - None Preferred - None SKILLS - Written and oral communication skills - Time management and organizational skills - Knowledge of ADA/CDT codes and general dental terminology - Negotiation skills - Ability to analyze situations, determine points of relevance and proper course of actions Language Requirement (other than English) None Travel Required 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches / trains others regularly Does Not Apply Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $50,200.00 Pay Range Maximum: $91,200.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Role Description Navitus Health Solutions is seeking a Pharmacy Relations Specialist (PRS II) to join our team! The Pharmacy Relations Specialist (PRS II) is a highly motivated professional with at least 2 years of successful experience working in a pharmacy or interfacing directly with pharmacies or accounts, preferably in healthcare. Responsibilities include executing contracts with pharmacies, responding to pharmacy inquiries, and completing the tactical and operational tasks required to maintain contracted pharmacy networks. How do I make an impact on my team? - Manage pharmacy contracting process with independent pharmacies and select chains/PSAOs and assist management with network negotiations; inclusive of redline reviews. - Review pharmacy contract setup to ensure compliance with pharmacy network agreements. - Support pharmacy audits and network compliance initiatives. - Research and problem solve to resolve claim issues and concerns. - Respond to and track requests, inquiries, and communications with network pharmacies. - Develop, review, and distribute pharmacy communications to meet internal and client requests. - Monitor, track, and report pharmacy compliance with guiding government regulations and internal policies and procedures. - Reviews and responds to independent pharmacy redlines; with little to no input from senior leadership. - Responsible for all aspects of maintenance related to pharmacy network functions, such as, network plan design builds, quality assurance measures and claims processing in general. - Other duties as assigned. Qualifications - College or 2-year Technical Degree or equivalent experience is preferred. Advanced technical education a plus. - Certified Pharmacy Technician preferred. - 3 years business-setting experience. - Retail pharmacy experience or experience in a managed care pharmacy setting desired. - Prior experience analyzing medical and/or pharmacy claims or credentials are highly desired. - Proficient in Microsoft Office and industry related software. - Participate in, adhere to, and support compliance program objectives. - The ability to consistently interact cooperatively and respectfully with other employees. Requirements - Pay Range: USD $47,309.00 - USD $56,321.00 /Yr. - STAR Bonus % (At Risk Maximum): 5.00 - Salaried Non-Management except pharmacists. - Work Schedule: M-F 8:30am-5pm. - Remote Work Notification: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming. Benefits - Top of the industry benefits for Health, Dental, and Vision insurance. - 20 days paid time off. - 4 weeks paid parental leave. - 9 paid holidays. - 401K company match of up to 5% - No vesting requirement. - Adoption Assistance Program. - Flexible Spending Account. - Educational Assistance Plan and Professional Membership assistance. - Referral Bonus Program – up to $750!

Job Description Patient Care Coordinator (Customer Service Associate Analyst) Evernorth Health Services | CarepathRx Position Summary Do you enjoy making a real difference in patients’ lives while working in a fast-paced healthcare environment? As a Patient Care Coordinator, you play a vital role in supporting infusion patients by ensuring their therapies, supplies, and services are delivered accurately and on time. You will partner closely with pharmacy, nursing, operations, reimbursement, and distribution teams to create a smooth, reliable, and compassionate patient experience. This role is ideal for someone who is organized, service-oriented, and motivated to grow within specialty and infusion pharmacy care. Schedule: Rotating shifts between 8:00 AM – 6:30 PM EST, Monday–Friday Responsibilities - Support the clinical management of infusion patients by coordinating medication refills, supplies, and services under the supervision of a licensed pharmacist. - Ensure patient supply inventories are accurate and complete, helping to prevent delays in care and treatment interruptions. - Collect and document medication profiles, patient updates, and assessments clearly and accurately in the medical record. - Serve as a key communication link between patients, infusion pharmacy teams, nursing, operations, reimbursement, and distribution partners. - Partner with reimbursement and distribution teams to ensure payer-specific requirements are followed, including delivery restrictions and collection processes. - Maintain high standards for quality, accuracy, productivity, and timeliness while meeting or exceeding defined performance goals. - Deliver consistently positive internal and external customer experiences through professional, empathetic, and solution-focused communication. - Support day-to-day pharmacy and operations workflows, including documentation handling, equipment coordination, and delivery or pickup preparation. - Demonstrate Evernorth’s system-wide competencies by working collaboratively, adapting to change, and contributing to continuous improvement. Qualifications: Required Qualifications High school diploma or equivalent. Minimum of 1 year of experience in customer service, healthcare support, pharmacy services, or a related role. Experience communicating with customers or patients by phone, email, or in person. Strong organizational, time management, and multitasking skills. Comfort using computers, Microsoft Office applications, and healthcare or pharmacy systems. Preferred Qualifications Experience in pharmacy customer service, pharmacy technician support, home infusion, specialty pharmacy, or homecare. Familiarity with infusion therapy workflows or ancillary healthcare provider environments. Demonstrated ability to prioritize competing tasks while maintaining attention to detail. Associate’s or Bachelor’s degree in a related field. As part of Evernorth Health Services, this role supports CarepathRx within our Pharmacy and Care Delivery organization. Our teams are ambitious, compassionate experts dedicated to advancing specialty pharmacy and infusion services in partnership with hospitals and health systems—always with patients at the center of what we do. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 20 - 30 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Job Description Performs a variety of registration, insurance verification, scheduling and billing duties in support of inpatient and outpatient access to medical services. Completes complex tasks. May aid or train other Representatives in responsibilities. Job Responsibility - Performs admissions, registration and scheduling activities. Obtains necessary demographic and insurance information and enters data into computer system, which may include patients on Medicare/Medicaid; - Verifies patient insurance coverage and other related data. Obtains patient insurance authorization required for services; Documents authorization approvals and denials in computer systems; may financially screen patients, evaluating and assessing all self-pay patients pre-registered or inpatient/outpatient, to establish method of payment; Informs and counsels patient/patient representative regarding available financial assistance; Collects money due from patient at time of service; May preform billing, receivable and related functions. - May follow through on any open self-pay accounts including monthly payment amounts for purposes of collection. - Assists and/or trains new employees as instructed by supervisor or manager. - Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions. Job Qualification - High School Diploma or equivalent required. - 3-5 years of relevant experience, required. Remote Monday-Friday 10am-6pm. Holidays and weekends as needed. *Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).