Provider Data Management Representative I

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

• 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.

What will YOU be working on every day?

• 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

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/client issues, experience managing large quantities of data accurately and efficiently, experience identifying and resolving data discrepancies
• Required Knowledge, Skills, and Abilities
  • 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

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

• Preferred Level of Education, License, and/or Certificates
  • 2 year degree or some formal education beyond high school
• Preferred Level of Experience
  • 1-2 years in a data management or provider data management 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: $17.88 - $26.81

Compensation Midpoint: $22.35