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 issues, coordinating with internal staff, and resolving concerns for high-value providers. The role uses market and provider knowledge and recruiting practices to address network deficiencies. The position is based in Maryland and requires the representative to live in Allegany, Frederick, or Carroll County. The representative works in the field three to four days per week and from a home office the remainder of the time. The representative builds and maintains provider relationships, conducts office visits and audits, develops and delivers provider training, and supports providers and clients with complex claims, authorizations, and reimbursement questions. The role also identifies network gaps, recruits potential providers, arranges out-of-network care through single case agreements, maintains provider network data, coordinates advisory board meetings, develops community partnerships, and supports credentialing and network development strategies. Additional duties include documenting provider communications, contributing training topics and materials, assisting with administrative tasks, and analyzing market, system, and operational trends with clients and providers to propose improvements to experience and cost.

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 Allegany County, Frederick County, or Carroll County, Maryland.
Able to work in the field three to four days per week and from a home office the remainder of the time.

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 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 to clients and providers in resolving complex claims and authorization issues.
Use provider-related Enterprise System modules to research claims and reimbursement questions.
Assess issues raised by provider offices and direct them to appropriate internal resources when needed.
Identify potential market deficiencies and network with others to obtain referrals for potential providers.
Recruit potential providers and discuss contract terms or negotiations to address network deficiencies.
Arrange care with out-of-network providers through single case agreements, including recommending providers, negotiating fees, and securing agreements.
Maintain accurate, up-to-date data on client-owned provider networks using automated systems and resolve 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 the department with administrative tasks and additional duties as needed.
Work with clients and providers to analyze market, system, and operational trends and propose solutions to improve client, provider, and member experience or reduce costs.
Document provider communications in organizational applications.