Provider Relations Representative I

What are important things that YOU need to know about this role?

• Experience Required: 1-2 years of experience in customer support, provider relations, or a similar role resolving complex or escalated issues. Experience working with healthcare providers, insurance/claims, or high-touch client environments is a strong plus. Ideal candidates are confident communicators who can navigate challenging conversations, build relationships, and problem-solve across teams
• Work Location: Enjoy the flexibility of working from wherever you do your best work-this is a permanent remote opportunity that empowers you to stay connected, productive, and supported from day one.
• Hours: Flexible, Monday through Friday Day Shift Hours

What will YOU be doing for us? Manage provider experience and relationships once the contracting and credentialing processes are completed. Deliver outreach and education to newly credentialed providers regarding best practices to ensure success in working with Skygen as they enter the network as well as resolutions to common issues and questions. Deliver ongoing provider outreach and education to participating network providers and collect feedback on their experience. Handle routine to moderate complexity provider issues including areas such as escalated claim resolution, potential record discrepancies, provider submission errors, single case agreements and electronic set up. 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.

What will YOU be working on every day?

• Conduct timely outreach to newly credentialed provider offices and review best practices, frequently asked questions 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 area of claim and authorization submissions and electronic relationships
• Modify provider records in the system and observe discrepancies in information received and entered. Request clarification or advise Provider Data Management Team Lead/Manager of issues related to data.
• Utilize the Provider-related modules in the Enterprise System to research claim, reimbursement and utilization questions.
• Complete follow ups, OnTime tickets, and emails according to the 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 generated from clients, providers and internal sources
• Resolve member access to care issues by researching providers and arranging letter of agreement with out of network providers
• Using automated systems, maintain updated records on client and Skygen owned provider networks by verifying accuracy and handling any exceptions or issues
• Act as a liaison between providers and Client Services to resolve escalated contracting and fee issues for client and Skygen owned provider networks.
• Act as a liaison between providers and Dental Reimbursement to resolve any 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 that involve in depth knowledge of plan or market information.
• Based on interactions with provider offices, offer suggestions for improving the overall provider experience

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

• Required Level of Education, Licenses, and/or Certificates
  • High school diploma or equivalent
• Required Level of Experience
  • 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).
• Required Knowledge, Skills, and Abilities
  • Intermediate knowledge of Microsoft Office products including Word, Excel, and Outlook
  • Excellent 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
  • Good problem solving and decision making skills
  • Ability to manage through difficult conversations

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

• Preferred Level of Education, License, and/or Certificates
  • 2 year degree/Bachelor's Degree
  • Experience in working with healthcare providers helpful
• Preferred Level of Experience
  • 1-3 years in a Provider Relations or Senior Customer Support role
• Preferred Knowledge, Skills, and Abilities
  • Knowledge of standard dental, medical and/or therapy terminology
  • Knowledge of internal software

The salary range and midpoint 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.

Compensation Range: $16.51 - $24.76 per hour ($34,336-$51,504/yr)

Compensation Midpoint: $20.63 per hour ($42,920/yr)