Note: The job is a remote job and is open to candidates in USA. SKYGEN is the trusted partner for specialty benefits payers and government agencies responsible for the delivery and administration of dental and vision benefits. The Provider Data Management Representative I will manage provider directories, resolve data discrepancies, and ensure accurate data entry and maintenance within the Enterprise system.
Responsibilities
- 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
- 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
Skills
- High school diploma or equivalent
- 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
- 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
- Excel Experience is Required
- 2 year degree or some formal education beyond high school
- 1-2 years in a data management or provider data management role
- Knowledge of standard dental, medical and/or therapy terminology
- Knowledge of internal software
- SQL Experience is Preferred
Company Overview
SKYGEN transforms dental and vision benefits management and administration with flexible technology and services that connect and change lives for the better. It was founded in 2015, and is headquartered in Menomonee Falls, Wisconsin, USA, with a workforce of 501-1000 employees. Its website is https://skygenusa.com/.
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