Field Provider Relations Representative

SKYGEN; Menomonee Falls (WI); Hybrid; USD 65,000 - 90,000; Full time

Job summary

SKYGEN is seeking a field-based Provider Relations professional in Maryland. You will spend 3–4 days per week in the field and work from a home office the rest of the time to support specific markets by researching providers and resolving network deficiencies.

You’ll build relationships with providers, conduct audits and meetings, develop training materials, and promote the Dental Hub portal while coordinating with internal staff to improve client/provider member experiences and reduce costs.

Qualifications

• 3–5 years of job related experience (provider relations, account management, or managed care).
• Excellent written and verbal communication skills.
• Ability to think strategically regarding market direction, provider needs and client relationship.
• Ability to build and maintain collaborative working relationships with diverse individuals.
• Ability to exercise influence without formal authority.
• Ability to ensure timely problem resolution despite multiple priorities.
• Intermediate knowledge of Microsoft Office (Word, Excel, email).

Responsibilities

• Build and maintain provider network relationships with regular communication and timely problem resolution.
• Conduct annual dental office visits.
• Conduct site audit data collection.
• Conduct mobile unit audits.
• Develop training and presentation materials tailored to market needs.
• Host regular training sessions for providers.
• Promote use of Dental Hub (provider web portal).
• Resolve complex claim and authorization issues for clients/providers.
• Research claim and reimbursement questions using Enterprise System modules.
• Assess issues from provider offices and route to appropriate contacts.
• Identify market deficiencies and derive referrals for potential providers.
• Recruit providers and discuss contract terms to resolve network deficiencies.
• Arrange care with out-of-network providers for single case agreements.
• Maintain client-owned networks data and handle exceptions.
• Coordinate provider advisory board meetings.
• Develop community partnerships to increase program visibility.
• Support Credentialing and Network Development strategies.
• Provide feedback to Provider Relations on training topics.
• Assist department with administrative tasks and market trend analysis.
• Document provider communications in organizational applications.

Skills

Excellent communication

Strategic thinking

Collaborative skills

Influence without authority

Problem resolution

MS Office

Education

Bachelor's degree in related field or equivalent experience

Bachelor's Degree in Business or related field

Job description

What are important things that YOU need to know about this role based in Maryland?

• Seeking a self-driven rock star that has Medicaid experience - candidates must live in either Allegany County, Frederick County or Carroll County
• Given the nature of the work, the person will be in field 3 to 4 days per week and working from a home office the remainder of the time

What will YOU be doing for us?

Provide support to specific market by researching, working with internal staff, and providing resolution to high value providers. Utilize knowledge of market and potential providers to resolve specific network deficiency issues through proper recruiting practices.

What will YOU be working on?

• Build and maintain appropriate relationships with provider network by ensuring regular communications and timely problem resolution.
• Conduct annual dental office visits.
• Conduct site audit data collection.
• Conduct mobile unit audits.
• Develop training and presentation materials relative to market needs.
• Host regular training sessions for new and existing providers.
• Promote use of Dental Hub (provider web portal).
• Act as resource to both client and providers in the network to resolve complex claim and authorization issues.
• Utilize the provider-related modules in the Enterprise System to research claim and reimbursement questions.
• Accurately and timely assess issues presented from provider offices that can be handled by other internal resources and provide offices with appropriate contacts to obtain resolution.
• Utilizing follow up requests from internal staff or client direction, recognize potential market deficiencies and network to obtain referrals for potential providers.
• Recruit and work with potential providers to discuss potential contract terms or negotiations needed to resolve network deficiencies.
• Through establishment of positive relationships with providers in the geography, arrange care with out of network providers for single case agreements including recommending a provider, negotiating the fee and securing the single case agreement contract.
• Using automated systems, maintain updated data on client owned provider networks by verifying accuracy and handling any exceptions or issues.
• Coordinate and conduct provider advisory board meetings.
• Identify appropriate community relationships and develop partnerships designed at increasing visibility of client programs.
• Support Credentialing and Network Development strategies.

Additional Responsibilities:

• Provide feedback to Provider Relations team regarding potential topics for provider training references and materials.
• Assist department with administrative tasks and additional duties as needed.
• Work with Clients and Providers to analyze market, system and operational trends and develop and propose solutions and interventions to improve the client/provider/member experience and/or reduce costs.
• Document provider communication within organization applications.
• Work with Clients and Providers to analyze market, system and operational trends and develop and propose solutions and interventions to improve the client/provider/member experience and/or reduce costs.

What qualifications do YOU need to have to be GOOD candidate?

• Bachelor's degree in a related field or equivalent years of experience.
• 3-5 years of job related experience (provider relations, account management, or managed care).
• Excellent communication written and verbal communication skills.
• Ability to think strategically regarding the direction of the market, provider needs and the client relationship.
• Ability to build and maintain collaborative working relationships with diverse individuals.
• Ability to exercise influence without formal authority.
• Ability to ensure timely problem resolution despite multiple priorities.
• Intermediate knowledge of Microsoft Office products including Word, Excel, and email.

What qualifications do YOU need to have to be GREAT candidate?

• Bachelor's Degree in Business or a related field.
• Experience in a managed care environment.
• Experience working in the field or with field issues.
• Experience with government dental programs.