Field Provider Relations Representative - West Virginia

This role is based in West Virginia and requires a self-driven individual with Medicaid experience. The position involves field work 3 to 4 days per week, with the remainder of the time spent working from a home office.

Responsibilities

• Provide support to a specific market by researching, collaborating with internal staff, and resolving issues for high-value providers.
• Utilize market knowledge and provider relationships to address network deficiencies through effective recruiting practices.
• Build and maintain relationships with the provider network through regular communication and timely problem resolution.
• Conduct annual dental office visits and site audit data collection.
• Perform mobile unit audits.
• Develop training and presentation materials tailored to market needs.
• Host regular training sessions for new and existing providers.
• Promote the use of Dental Hub (provider web portal).
• Act as a resource for both clients and providers to resolve complex claim and authorization issues.
• Use provider-related modules in the Enterprise System to research claim and reimbursement questions.
• Assess and route provider office issues to appropriate internal resources for resolution.
• Identify potential market deficiencies and network to obtain referrals for new providers based on internal or client requests.
• Recruit and negotiate contract terms with potential providers to address network deficiencies.
• Arrange care with out-of-network providers for single case agreements, including fee negotiation and contract securing.
• Maintain updated data on client-owned provider networks using automated systems, verifying accuracy and handling exceptions.
• Coordinate and conduct provider advisory board meetings.
• Identify and develop community partnerships to increase the visibility of client programs.
• Support Credentialing and Network Development strategies.
• Provide feedback to the Provider Relations team on potential training topics and materials.
• Assist with administrative tasks and additional duties as needed.
• Analyze market, system, and operational trends to propose solutions that improve client, provider, and member experiences or reduce costs.
• Document provider communications within organizational applications.

Qualifications

Good Candidate

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

Great Candidate

• Bachelor’s Degree in Business or a related field.
• Experience in a managed care environment.
• Experience working in the field or with field-related issues.
• Experience with government dental programs.