SKYGEN · 4 days ago
Provider Data Management Representative I
United States
Full-time
Remote
Entry Level
$17.88/hr - $26.81/hr
1+ years expSKYGEN 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.
Health CareInsurance
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
Qualification
Required
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
Preferred
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
SKYGEN
SKYGEN transforms dental and vision benefits management and administration with flexible technology and services that connect and change lives for the better.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Craig Kasten
CEO and Managing Partner
Steven J. Berryman
Chief Executive Officer
Recent News
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