Provider Data Management Representative I

SKYGEN

3d•$18 - $27•Remote

About The Position

Fully Remote & Flexible Hours: Enjoy the freedom of a permanent remote position with work hours from 8:00 AM to 4:30 PM Central, Monday through Friday Problem-Solving Pro: Tackle challenges head-on, applying sharp analytical skills to quickly break down issues and uncover the root cause with precision. Fast Learner & Critical Thinker: Thrive in a fast-paced environment where your ability to dig deep, think critically, and find solutions is key to success. Excel Experience is Required SQL Experience is Preferred What will YOU be doing for us? Manage provider directories, including entering data for new records, termination of existing records, and ongoing audits and corrections for active records. Utilize research and knowledge of network configurations and the Enterprise system to resolve provider data questions and discrepancies.

Requirements

High school diploma or equivalent
1 -2 years of prior related experience in resolving escalated and challenging customer/client issues, experience managing large quantities of data accurately and efficiently, experience identifying and resolving data discrepancies
Intermediate knowledge of Microsoft Office products including Word, Excel, and Outlook
Solid communication written and verbal communication skills
Ability to communicate effectively with a variety of communication styles
Strong analytical skills
Ability to effectively listen and respond to internal and external customer needs
Ability to resolve routine to moderately complex problems
Ability to adapt to changing priorities
Ability to successfully work cross-functionally to resolve problems
High degree of accuracy
Ability to recognize patterns and variation in data and identify errors
Excel Experience is Required

Nice To Haves

2 year degree or some formal education beyond high school
1-2 years in a data management or provider data management role
Knowledge of standard dental, medical and/or therapy terminology
Knowledge of internal software
SQL Experience is Preferred

Responsibilities

Set up newly activated provider records in the Enterprise system’s participating networks
Manually load rejected provider data into the Enterprise system, reviewing data for discrepancies in data received. Research or coordinate or escalate for clarification from the client for issues related to data received.
Perform quarterly data verification procedures in accordance with company procedures and CMS requirements, validating the provider network.
Coordinate with Provider Relations to conduct outreach to provider offices to resolve provider data questions and discrepancies
Utilize the Provider-related modules in the Enterprise System to research and resolve provider data set up issues and discrepancies
Complete follow ups, service tickets, and emails according to the department expectations.
Work with internal departments to resolve simple to moderately complex follow ups and service tickets generated from clients, providers and internal sources
Using automated systems, maintain updated data on client and Skygen owned provider networks by verifying accuracy and handling any exceptions or issues
Work directly with client representatives to resolve provider data issues and update provider data per client or provider request.
Act as a liaison between internal Skygen teams to resolve escalated contracting and fee issues related to provider data errors or discrepancies
Act as a liaison between internal Skygen team and Dental Reimbursement to resolve any escalated claim inquiry related to provider data errors or discrepancies
Work with internal departments to resolve provider complaints and escalations including state level complaints
Assist Client Services in researching and resolving client inquiries that involve in depth knowledge of provider set ups
Process EFT set up requests form provider offices