Field Provider Relations Representative - Southeastern PA, Philadelphia area

What You Need to Know

The role is based in southeastern Pennsylvania, specifically in the Philadelphia area. The position requires Medicaid experience and involves fieldwork 3 to 4 days per week with the remainder of the time spent working from a home office.

What Will You Be Doing?

• Support specific markets by researching and collaborating with internal staff to resolve high-value provider issues.
• Utilize knowledge of the market and potential providers to address network deficiencies through effective recruitment.
• Build and maintain relationships with the provider network, ensuring regular communications and timely problem resolution.
• Conduct annual dental office visits and site audits.
• Perform mobile unit audits and develop training materials relevant to market needs.
• Host regular training sessions for new and existing providers and promote the use of the Dental Hub.
• Resolve complex claim and authorization issues using the provider-related modules in the Enterprise System.
• Accurately assess and handle issues presented from provider offices, directing them to appropriate contacts for resolution.
• Identify potential market deficiencies and network to obtain referrals for potential providers.
• Recruit and negotiate with potential providers to establish single case agreements and contracts.
• Maintain accurate and up-to-date data on client-owned provider networks, addressing any exceptions or issues.
• Coordinate and conduct provider advisory board meetings.
• Develop and maintain community relationships and partnerships to increase program visibility.
• Provide feedback to the Provider Relations team on potential training topics and materials.
• Assist with administrative tasks and additional duties as assigned.
• Work with clients and providers to analyze market, system, and operational trends and develop solutions to improve the client/provider/member experience and reduce costs.
• Document provider communication within organization applications.
• Collaborate with clients and providers to analyze trends and develop interventions to enhance the client/provider/member experience and reduce costs.

Qualifications for a Good Candidate

• Bachelor’s degree in a related field or equivalent experience.
• 3-5 years of job-related experience in provider relations, account management, or managed care.
• Excellent communication skills, both written and verbal.
• Strategic thinking regarding market, provider needs, and client relationships.
• Ability to build and maintain collaborative relationships with diverse individuals.
• Ability to exercise influence without formal authority.
• Proven ability to ensure timely problem resolution despite multiple priorities.
• Intermediate knowledge of Microsoft Office products, including Word, Excel, and email.

Qualifications for a Great Candidate

• Bachelor’s degree in Business or a related field.
• Experience in a managed care environment.
• Field experience or familiarity with field issues.
• Experience with government dental programs.