Provider Relations Representative I

SKYGEN•United States,

3d•Remote

About The Position

This role focuses on managing and enhancing the experience of healthcare providers after their contracting and credentialing are complete. The Provider Relations Representative will be responsible for outreach, education, and issue resolution to ensure providers have a successful working relationship with Skygen. This includes educating new providers on best practices, addressing common issues, and collecting feedback from existing network providers. The role also involves handling moderate complexity provider issues such as escalated claims, record discrepancies, and electronic setup, while contributing to maintaining adequate provider networks through outreach activities.

Requirements

High school diploma or equivalent
1-2 years of prior related experience in resolving escalated and challenging customer issues (i.e. collections, retail management, or senior customer service based roles).
1-2 years of experience in customer support, provider relations, or a similar role resolving complex or escalated issues.
Intermediate knowledge of Microsoft Office products including Word, Excel, and Outlook
Excellent 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
Good problem solving and decision making skills
Ability to manage through difficult conversations

Nice To Haves

Experience working with healthcare providers, insurance/claims, or high-touch client environments is a strong plus.
2 year degree/Bachelor’s Degree
Experience in working with healthcare providers helpful
1-3 years in a Provider Relations or Senior Customer Support role
Knowledge of standard dental, medical and/or therapy terminology
Knowledge of internal software

Responsibilities

Manage provider experience and relationships once contracting and credentialing processes are completed.
Deliver outreach and education to newly credentialed providers regarding best practices and common issues.
Deliver ongoing provider outreach and education to participating network providers and collect feedback.
Handle routine to moderate complexity provider issues including escalated claim resolution, record discrepancies, provider submission errors, single case agreements, and electronic setup.
Assist in maintaining adequate provider networks through outreach activities related to credentialing and recredentialing.
Observe provider experience trends and make suggestions for improving the overall provider experience program.
Conduct timely outreach to newly credentialed provider offices and review best practices, FAQs, and common issues.
Conduct proactive outreach to existing provider offices to collect feedback, identify issues, and provide education.
Participate in outreach campaigns designed to change provider behavior in areas of claim and authorization submissions and electronic relationships.
Modify provider records in the system, observe discrepancies, and request clarification or advise the Provider Data Management Team Lead/Manager of issues related to data.
Utilize Provider-related modules in the Enterprise System to research claim, reimbursement, and utilization questions.
Complete follow ups, OnTime tickets, and emails according to department expectations and SLAs.
Work with internal departments to produce, maintain, and deliver provider training references and materials.
Work with internal departments to resolve simple to moderately complex outstanding follow ups and OnTime tickets.
Resolve member access to care issues by researching providers and arranging letters of agreement with out-of-network providers.
Maintain updated records on client and Skygen owned provider networks by verifying accuracy and handling exceptions or issues.
Act as a liaison between providers and Client Services to resolve escalated contracting and fee issues.
Act as a liaison between providers and Dental Reimbursement to resolve claim inquiry related issues in escalated situations.
Work with internal departments to resolve provider complaints and escalations, including state-level complaints.
Assist Client Services in researching and resolving client inquiries involving in-depth knowledge of plan or market information.
Offer suggestions for improving the overall provider experience based on interactions with provider offices.