Field Provider Relations Representative

SKYGEN•United States,

2d•$62,676 - $94,014•Hybrid

About The Position

The Field Provider Relations Representative supports a specific market by researching provider issues, coordinating with internal staff, and resolving concerns for high-value providers. The representative uses knowledge of the market and potential providers to address network deficiencies through provider recruiting. The position is based in Maryland, and candidates must live in Baltimore City or Baltimore County. The work is performed in the field three to four days per week, with the remainder from a home office. The role builds and maintains provider relationships, conducts dental office visits and audits, delivers provider training, and helps providers and clients resolve complex claims and authorization issues. It also supports network development, credentialing strategies, provider contracting, and community partnerships. The representative analyzes market, system, and operational trends with clients and providers and proposes solutions to improve the client, provider, and member experience or reduce costs. Provider communications and network data must be documented and maintained using organizational applications and automated systems.

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 live in Baltimore City or Baltimore County, Maryland.
Medicaid experience is sought.

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, collect site-audit data, and conduct mobile-unit audits.
Develop training and presentation materials based on market needs and host training sessions for new and existing providers.
Promote use of the Dental Hub provider web portal.
Serve as a resource for clients and providers in resolving complex claim and authorization issues.
Use provider-related Enterprise System modules to research claim and reimbursement questions.
Assess issues from provider offices and direct offices to appropriate internal contacts when another resource is needed for resolution.
Identify potential market and network deficiencies and seek referrals for potential providers.
Recruit and work with potential providers to discuss contract terms or negotiations addressing network deficiencies.
Arrange out-of-network care through single-case agreements, including recommending providers, negotiating fees, and securing agreements.
Maintain and verify client-owned provider-network data in automated systems and address exceptions or issues.
Coordinate and conduct provider advisory board meetings.
Identify community relationships and develop partnerships that increase visibility of client programs.
Support credentialing and network development strategies.
Provide the Provider Relations team with feedback on topics for provider training references and materials.
Assist with administrative tasks and additional duties as needed.
Analyze market, system, and operational trends with clients and providers, and propose solutions to improve the client, provider, or member experience or reduce costs.
Document provider communications in organizational applications.