JobsEQ by Chmura Logo

Provider Relations Representative

Argus Dental & Vision, Inc.

Location: Tampa, FL 33607
Type: Non-Remote
Posted on: February 18, 2021
This job is no longer available from the source.
Provider Relations Representative
Argus Dental & Vision, Inc.
27 reviews
Tampa, FL 33607
Argus Dental & Vision, Inc.
27 reviews
Read what people are saying about working here.
Job Summary
The PR Representative supports participating network providers to ensure and maintain provider network efforts with a focus on maintaining regulatory compliance with accreditation standards and accuracy of Provider network information.
Summary of Essential Job Functions
• Conduct continuing Provider training and training to familiarize Providers with Argus processes and communication channels
• Submit data configuration request for provider record changes and updates
• Manages large DSO/VSO groups by having regular communications with these groups
• Makes daily phone calls to providers and groups in assigned geographical territory
• Submit fee increase request to Network Development when required
• Ensure provider understands and educates provider on the Argus Provider Agreement
• Research and assist providers in claim issues for a resolution
• Manages escalated provider searches for members and health plans as requested
• Assist other departments with grievances and appeals as needed
• Reach out to Providers via phone to complete compliance-related calls (i.e. Secret Shopper, After Hours) and directory maintenance, ensuring all collected information is entered per department expectations
• Document all Provider interactions in Argus systems per management direction
• Perform network audit duties as necessary to ensure Provider directory accuracy and compliance with accreditation standards
• Make updates and provider outreach for ongoing provider directory updates in partnership with Constellation4
• Maintain the Provider Relations email inbox to ensure quick resolution
• Contribute to a positive working environment that motivates the team to be successful
• Meet and exceed performance goals consistently
• Comply with Argus policy and procedures and accreditation standards
• Other duties and responsibilities as assigned by management
Required Knowledge, Skills and Abilities
• Travel may be required as and when required. (10%-15%)
• High school diploma, Associate Degree preferred or higher education
• Ability to navigate complex health plan enterprise systems
• Efficient and concise communication skills
• Organized with excellent time-management capabilities
• Strong analytical and problem-solving skills
• Ability to analyze data for identifying trends and variance from goals
• Ability to work autonomously
• Detail-oriented
• Ability to multi-task effectively
• Microsoft Suite knowledge is a must.
Experience
• 3+ years of work experience in the dental and vision sectors or related experience
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.