Plan Management Specialist

Company: Aspen Dental
Location: East Syracuse
Posted on: September 1, 2024

Job Description:

The Aspen Group (TAG) is one of the largest and most trusted retail healthcare business support organizations in the U.S., supporting 15,000 healthcare professionals and team members at more than 1,000 health and wellness offices across 47 states in three distinct categories: Dental care, urgent care, and medical aesthetics. Working in partnership with independent practice owners and clinicians, the team is united by a single purpose: to prove that healthcare can be better and smarter for everyone. TAG provides a comprehensive suite of centralized business support services that power the impact of five consumer-facing businesses: Aspen Dental, ClearChoice Dental Implant Centers, WellNow Urgent Care, AZPetVet and Chapter Aesthetic Studio. Each brand has access to a deep community of experts, tools and resources to grow their practices, and an unwavering commitment to delivering high-quality consumer healthcare experiences at scale.

As a reflection of our current needs and planned growth we are very pleased to offer a new opportunity to join our dedicated team as a Plan Management Specialist.

Team Overview

The Plan Management team is made up of three groups to support accountability, for task allocation purposes and to foster an environment in which we are developing best-in-class subject matter experts. The entire Plan Management team owns and oversees all system features that drive the insurance estimate. Treatment plan estimates are generated by Aspen branded office teams using a proprietary "Enterprise Practice Management System" (EPMS). Treatment plan estimates are presented to the patient in good faith, and inaccuracies affect many areas of the business including patient satisfaction, bad debt billing, and provider net revenue. All groups in the Plan Management team have influence over insurance estimate accuracy and office experience whether it be ensuring accurate fee schedule and plans are available, acting as a coach and mentor for the office teams, or proposing innovative enhancements to our process and or system.

Qualifications

• Associate degree or 2+ years in dental
  
• Experience with working at a DSO or insurance payor
  
• Must be able to work independently.
  
• Must be able to work remotely with little to no supervision.
  
• Strong verbal and written communication skills
  
• Excellent computer skills including Service Now, SharePoint, Outlook, Excel, Word, Teams and One Note
  
• Detail oriented with above average ability to organize projects and time management.
  
• Excellent communication and customer service skills to both internal and external individuals
  
• Ability to analyze and process information, identify problems and trends and develop effective solutions and strategies
  
  
  Breakdown of Groups:
  
  Fee & Contract Integrity: Responsible for the intake and organization of all fee schedules for Aspen Dental branded practices. This group will also convert fee schedules into excel as needed and import to practice management systems.
  
  • Review + save fee schedules in a uniform format
    
  • Maintain database of rates for all plans
    
  • Maintain tracker of fee schedule updates and proactively reach out to plans on anniversary date.
    
  • Fee Key management for each Payor based on coverage locations.
    
  • Import fee schedules into AS400 / EPMS P3 Maintain relationships with each Payor, as assigned. Will be primary POC with Payors.
    
  • Maintain system and review active fee schedules, terming inactive schedules from the system.
    
  • Gather and confirm new offices fee schedules prior to opening and keep Keys updated
    
  • Communicate impact to leadership on any new / updated rates.
    
  • Actively participate in rate audit process
    
  • Support Estimate Accuracy review as the SME of contracted fees Partner with internal Practice Support Teams on fee-related inquiries as needed.
    
  • Review payor polices + updates and communicate as needed
    
  • Support training initiatives within team as set by leadership
    
    
    Plans & Records: Responsible for the internal system maintenance of payor and industry records that impact the estimation, charge out and claim process for treatment performed in Aspen Dental branded practices. This role works closely with internal partners.
    
    Confirm fee schedules are in correct format prior to being published to internal clients Identify and term plans in EPMS not in use by carrier Obtain plan detail from internal resources, carrier websites, Availity, etc. Enhance naming conventions to support field user success Update system to align with provider participation status changes at the carrier Partner with internal Practice Support Teams as needed CDT & Aspen Procedure code maintenance in EPMS system 270/271 EDI Transaction (Electronic Eligibility) Projects Back-up coverage for Field-Facing tickets at manager's request Support training initiatives within team as set by leadership Payor / Plan / Group record creation and maintenance
    
    • Group Limits & exclusions
      
    • Payor ID's and addresses
      
    • Other records, as needed
      
      
      Field Facing & Training: Responsible for all responses to Aspen Dental branded practices via tickets and e-mail. Through this process, the group will identify opportunities with insurance carrier materials, and ways we can help enhance internal Aspen training modules and Insurance Verification Form used in practice management system (EPMS). Working hours are set to ensure coverage on Service Now until 3:00PM Pacific Standard Time.
      
      • Respond to Service Now Tickets & e-mail queue timely and effectively
        
      • Work with leadership on identifying trends to implement and execute into trainings and field facing material in our SharePoint Libraries
        
      • Partner with internal Practice Support Teams as needed
        
      • Subject matter expert on all things related to the Insurance Verification Form (IVF)
        
      • Support training initiatives within team as set by leadership
        
        
        Salary: $22 - 26/ hr

Keywords: Aspen Dental, Syracuse , Plan Management Specialist, Executive , East Syracuse, New York