Field Provider Relations Representative

SKYGEN; Menomonee Falls (WI); Hybrid; USD 60,000 - 90,000; Full time

Job summary

SKYGEN is seeking a field-focused Provider Relations Specialist to support West Virginia markets. The role involves building provider networks, conducting audits and office visits, and delivering training to improve the client/provider experience.

You will work three to four days in the field and the remainder from a home office, collaborating across internal teams to resolve complex claims and drive market improvements.

Qualifications

• Bachelor's degree in a related field or equivalent years of experience.
• 3-5 years of provider relations, account management, or managed care experience.
• Excellent written and verbal communication skills.
• Strategic thinking about market direction and client relationships.
• Ability to build collaborative relationships with diverse individuals.
• Ability to influence without formal authority.
• Ability to ensure timely problem resolution with multiple priorities.
• Proficiency in Word, Excel, and email.

Responsibilities

• Build and maintain relationships with provider network and ensure timely problem resolution.
• Conduct annual dental office visits.
• Conduct site audit data collection.
• Conduct mobile unit audits.
• Develop training and presentation materials.
• Host regular training sessions for providers.
• Promote use of Dental Hub portal.
• Resolve complex claim and authorization issues for clients/providers.
• Research claim and reimbursement questions using Enterprise System modules.
• Route issues to appropriate internal contacts.
• Identify market deficiencies and network for referrals.
• Recruit providers and discuss contract terms to resolve network deficiencies.
• Arrange care with out-of-network providers for single-case agreements.
• Maintain provider network data accuracy in client systems.
• Coordinate provider advisory board meetings.
• Develop community relationships to increase client program visibility.
• Support Credentialing and Network Development strategies.

Skills

Communication skills

Strategic thinking

Relationship building

Influence without authority

Problem resolution

MS Office

Education

Bachelor's degree in related field

Tools

Microsoft Office

Job description

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

• Seeking a self-driven rock star that has Medicaid experience - located in West Virginia.
• 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.