[Remote] Provider Data Management Representative I

Note: The job is a remote job and is open to candidates in USA. SKYGEN USA is a company that focuses on provider data management, and they are seeking a Provider Data Management Representative I. In this role, you will manage provider directories, resolve data discrepancies, and coordinate with various teams to ensure accurate provider information.

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
• 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

Company Overview