Field Provider Relations Specialist — Maryland

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

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.