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Dental Field Provider Relations Representative
Dental Field Provider Relations RepresentativeSKYGEN • Menomonee Falls, WI, United States
Dental Field Provider Relations Representative

Dental Field Provider Relations Representative

SKYGEN • Menomonee Falls, WI, United States
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  • serp_jobs.job_card.full_time
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What are important things that YOU need to know about this role based in Georgia?

  • Seeking three self-driven rock stars that have Medicaid experience - two will be located around the Atlanta area and one will be located in the southern part of Georgia.
  • As a result of successful program expansion, these are newly created positions working with the state of GA.
  • Given the nature of the work, the person will be in field 3 to 4 days per week and working from a home office the remainder of the time.

What will YOU be doing for us? Provide support to specific market by researching, working with internal staff, and providing resolution to high value providers. Utilize knowledge of market and potential providers to resolve specific network deficiency issues through proper recruiting practices.

What will YOU be working on?

  • Build and maintain appropriate relationships with provider network and clients by ensuring regular communications and timely problem resolution.
  • Develop training and presentation materials relative to market needs.
  • Host regular training sessions for new and existing providers to promote use of provider web portal and address questions on any other necessary procedures.
  • Act as resource to both client and providers in the network to resolve complex claim issues for high volume or high value provider offices.
  • Utilize the provider-related modules in the Enterprise System to research claim and reimbursement questions.
  • Accurately and timely assess issues presented from provider offices that can be handled by other internal resources and provide offices with appropriate contacts to obtain resolution.
  • Utilizing follow up requests from internal staff or client direction, recognize potential market deficiencies and network to obtain referrals for potential providers.
  • Recruit and work with potential providers to discuss potential contract terms or negotiations needed to resolve network deficiencies.
  • Through establishment of positive relationships with providers in the geography, arrange care with out of network providers for single case agreements including recommending a provider, negotiating the fee and securing the single case agreement contract.
  • Through regular networking events, maintain contact with potential clients and provide any necessary information to generate potential interest.
  • Work collaboratively with internal sales staff to relay potential leads for sales opportunities.
  • Using automated systems, maintain updated data on client owned provider networks by verifying accuracy and handling any exceptions or issues.
  • Coordinate and conduct provider advisory board meetings and town hall meetings.
  • Identify appropriate community relationships and develop partnerships designed at increasing visibility of client programs.
  • Build and maintain relationships within SKYGEN.
  • Support Credentialing and Network Development strategies.

    • Additional Responsibilities :

  • Provide feedback to Provider Relations team regarding potential topics for provider training references and materials.
  • Field calls from medical, dental, vision, and therapy providers with questions on the provider web portal.
  • Assist department with administrative tasks and additional duties as needed.
  • Conduct site audit data collection.
  • Conduct mobile unit audits.
  • Work with Clients and Providers to analyze market, system and operational trends and develop and propose solutions and interventions to improve the client / provider / member experience and / or reduce costs.

    • What qualifications do YOU need to have to be GOOD candidate?

  • Bachelor's degree in a related field or equivalent years of experience.
  • 3-5 years of job related experience (provider relations, account management, or managed care).
  • Excellent communication written and verbal communication skills.
  • Ability to think strategically regarding the direction of the market, provider needs and the client relationship.
  • Ability to build and maintain collaborative working relationships with diverse individuals.
  • Ability to exercise influence without formal authority.
  • Ability to ensure timely problem resolution despite multiple priorities.
  • Intermediate knowledge of Microsoft Office products including Word, Excel, and email.

    • What qualifications do YOU need to have to be GREAT candidate?

  • Bachelor's Degree in Business or a related field.
  • Experience in a managed care environment.
  • Experience working in the field or with field issues.

    • The salary range is listed below for your reference. Please keep in mind that your education and experience along with your knowledge, skills and abilities are taken into consideration when determining placement within the range.

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    Field Representative • Menomonee Falls, WI, United States

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