[Hiring] Provider Data Management Representative I @SKYGEN

Role Description

This role involves managing provider directories and ensuring data accuracy within the Enterprise system.

• Manage provider directories, including entering data for new records, termination of existing records, and ongoing audits and corrections for active records.
• 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.
• Perform quarterly data verification procedures in accordance with company procedures and CMS requirements.
• 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 setup issues and discrepancies.
• Complete follow-ups, service tickets, and emails according to department expectations.
• Work with internal departments to resolve simple to moderately complex follow-ups and service tickets generated from clients, providers, and internal sources.
• Maintain updated data on client and Skygen owned provider networks using automated systems.
• 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 escalated claim inquiries 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 setups.
• Process EFT setup requests from provider offices.

Qualifications

• 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 written and verbal communication skills
• 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
• High degree of accuracy
• Ability to recognize patterns and variation in data and identify errors

Requirements

• 2 year degree or some formal education beyond high school (preferred)
• 1-2 years in a data management or provider data management role (preferred)
• Knowledge of standard dental, medical and/or therapy terminology (preferred)
• Knowledge of internal software (preferred)

Benefits

• 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

Company Description

SKYGEN is the trusted partner for specialty benefits payers and government agencies responsible for the delivery and administration of dental and vision benefits. Through cutting-edge technology and service solutions, SKYGEN empowers clients to become the most efficient, effective healthcare organizations in the country.