Field Provider Relations Representative

SKYGEN•United States,

5d•$62,676 - $94,014•Hybrid

About The Position

This role is seeking a self-driven individual with Medicaid experience, located in the southeastern PA, Philadelphia area. The position requires the individual to be in the field 3 to 4 days per week, with the remainder of the time spent working from a home office. The primary function is to provide support to a specific market by researching, collaborating with internal staff, and resolving issues for high-value providers. This involves utilizing knowledge of the market and potential providers to address network deficiency issues through effective recruiting practices.

Requirements

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.

Nice To Haves

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.

Responsibilities

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.
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.