Job ID 477
Offered Salary 2900
Career Level others
Experience 3 Years
Full Job Description
What are important things that YOU need to know about this role?
- This is a newly created position working with a West coast client. Although this position can be based anywhere in the U.S., the person will need to have a flexible schedule to accommodate potential time zone differences.
- Seeking someone with strong listening and communication skills who can facilitate tracking, executing and reporting on performance metrics with the providers.
What will YOU be doing for us? 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 re-credentialing. Observe provider experience trends and make suggestions for improving the overall provider experience program.
What will YOU be working on?
- 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 and 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?
- 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).
- Excellent communication written and verbal communication skills.
- Strong analytical skills along with the ability to resolve routine to moderately complex problems.
- Ability to provide high degree of accuracy with changing priorities.
- Intermediate knowledge of Microsoft Office products including Word, Excel, and Outlook.
What qualifications do YOU need to have to be GREAT candidate?
- Associates or 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.
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