Field Provider Relations Representative

SKYGEN•United States,

2d•$62,676 - $94,014•Hybrid

About The Position

The Field Provider Relations Representative supports a designated market by researching provider issues, coordinating with internal staff, and resolving concerns for high-value providers. The role uses knowledge of the market and potential providers to address network deficiencies through provider recruitment and relationship development. The person must be located in Maryland’s Eastern Shore Region. The work is field-based three to four days per week, with the remaining time spent working from a home office. The representative builds and maintains provider relationships, conducts office visits and audits, develops and delivers training, supports use of the Dental Hub provider portal, and helps resolve complex claims and authorization issues. The role also recruits providers, coordinates out-of-network care through single-case agreements, maintains provider network data, conducts advisory board meetings, and supports credentialing and network development strategies. Additional work includes documenting provider communications, analyzing market and operational trends with clients and providers, and proposing solutions to improve client, provider, and member experiences or reduce costs.

Requirements

Bachelor’s degree in a related field or equivalent years of experience.
Three to five years of job-related experience in provider relations, account management, or managed care.
Excellent written and verbal communication skills.
Ability to think strategically about market direction, provider needs, and client relationships.
Ability to build and maintain collaborative working relationships with diverse individuals.
Ability to influence without formal authority.
Ability to ensure timely problem resolution while managing multiple priorities.
Intermediate knowledge of Microsoft Office products, including Word, Excel, and email.
Must be located in the Eastern Shore Region of Maryland.
Medicaid experience.

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 provider network relationships through regular communication and timely problem resolution.
Conduct annual dental office visits, site audit data collection, and mobile unit audits.
Develop training and presentation materials for market needs and host training sessions for new and existing providers.
Promote use of the Dental Hub provider web portal.
Serve as a resource to clients and network providers on complex claims and authorization issues.
Use provider-related Enterprise System modules to research claims and reimbursement questions.
Assess provider-office issues and direct offices to appropriate internal contacts when other resources are needed.
Identify potential market and network deficiencies, obtain referrals for potential providers, and recruit providers to address deficiencies.
Discuss potential contract terms and negotiations with prospective providers.
Arrange out-of-network care through single-case agreements, including recommending providers, negotiating fees, and securing agreements.
Maintain and verify accurate data on client-owned provider networks using automated systems, and handle exceptions or issues.
Coordinate and conduct provider advisory board meetings.
Identify community relationships and develop partnerships to increase visibility of client programs.
Support credentialing and network development strategies.
Provide feedback to the Provider Relations team about provider training topics and materials.
Assist with administrative tasks and other duties as needed.
Work with clients and providers to analyze market, system, and operational trends and propose solutions to improve the client, provider, or member experience or reduce costs.
Document provider communications in organizational applications.