Provider Relations / Provider Services Specialist

Provider Services Specialist

Location: Plantation, FL (Onsite)

Employment Type: Full-Time

We are seeking a dedicated Provider Services Specialist to serve as the primary point of contact for dental providers and network partners, resolving escalated issues related to claims, credentialing, authorizations, payments, and plan benefits while ensuring an exceptional provider experience.

Key Responsibilities

• Manage escalated provider issues from intake through resolution.
• Respond to provider inquiries regarding claims, eligibility, benefits, fee schedules, and payment disputes.
• Coordinate with Claims, Credentialing, Contracting, and Client Services teams to resolve cross-functional issues.
• Support provider onboarding and orientation to company processes and requirements.
• Identify trends in provider complaints and recommend process improvements.
• Maintain escalation logs and track resolution metrics.
• Educate provider offices on benefits, authorization requirements, and billing guidelines.
• Support compliance initiatives, provider outreach programs, webinars, and office visits as needed.

Qualifications

• 1-3 years of experience in Provider Services, Provider Relations, Dental Operations, or Health Plan Operations.
• Knowledge of dental claims, CDT codes, and provider contracting concepts.
• Strong communication and customer service skills with the ability to de-escalate provider concerns.
• Ability to manage multiple priorities and follow issues through completion.
• Experience using CRM, ticketing systems, and Microsoft Excel.

Preferred Qualifications

• Experience with Medicare Advantage or Medicaid Managed Care programs.
• Experience working with DSOs, group practices, or specialty provider organizations.
• Experience supporting dental provider networks and provider operations.

If you're looking to grow your career in provider operations and healthcare services while making a direct impact on provider satisfaction and network success, we'd love to hear from you.

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