Director, Provider Experience

What are important things that YOU need to know about this role?

• This is a key leadership position reporting to our Chief Operating Officer that can be based remotely in the US!
• Seeking an experienced leader who knows networks for all products (Commercial, Medicare and Medicaid), has deep credentialing knowledge in the dental and vision space and can quickly learn the complexities of our business while delivering a great provider experience. 
• Travel would be about 15-20%, attending conferences and visiting clients and would have about a dozen direct reports.

What will YOU be doing for us?

The Director of Provider Experience is responsible for overseeing the Provider Experience department, ensuring the delivery of a world-class provider experience. This role will manage the Network Development, Credentialing, Field Provider Relations, Internal Provider Relations and Provider Data teams. The Director will develop and implement strategies to enhance provider satisfaction, streamline processes, meet service level obligations and ensure compliance with industry standards.

What will YOU be working on?   

• Leadership and Management:
  • Oversee the Credentialing, Field Provider Relations, Internal Provider Relations, and Network Development teams.
  • Develop and implement departmental procedures, quality measures, and set goals and objectives to ensure effective and compliant workflow.
  • Foster an environment of continuous improvement through process and systematic efficiencies.
  • Work in conjunction with Human Resources to evaluate viable candidates for hire, develop relevant interview questions, and utilize appropriate selection techniques.
  • Develop, train, and motivate staff. Initiate and communicate personnel actions including employment, terminations, performance reviews, salary reviews, disciplinary actions, and development plans.
  • Provide regular and behaviorally specific feedback to increase performance levels.
• Network Development:
  • Develop network strategies – in general and with respect to specific network builds – in coordination with Executive Leadership and Business Development Teams.
  • Oversee the Network Development team to ensure providers are contracted in accordance with requirements.
  • Review and approve special financial and other terms as applicable.
  • Track campaign recruiting and contracting results and provide appropriate reports to internal and external stakeholders.
  • Utilize statistical techniques to analyze data, develop and monitor key performance metrics.
• Credentialing:
  • Ensure providers are credentialed in a timely and accurate manner and in accordance with NCQA and, as appropriate, CMS requirements.
  • Resolve complex issues and provide feedback and training to ensure credentialing processes are completed accurately.
  • Serve as a subject matter expert regarding federal and multi-state regulatory requirements, NCQA and CMS requirements, company policy, and emerging industry trends.
• Dental Hub Provider Data Services:
  • Provide the guidance, thought leadership and subject matter expertise to ensure the Dental Hub’s Provider Data Services continue to lead the dental industry, while also delivering exceptional value to our clients and aligning with the company’s growth strategy.
  • Oversee and ensure the successful day-to-day operation of the Dental Hub's Provider Data Services.
  • Ensure proper operational support for each Provider Data Service.
  • Monitor and ensure compliance with all service level agreements for each Provider Data Service.
  • Identify opportunities to further automate each Provider Data Service.
  • Collaborate with the Product Manager to ensure optimal performance of the Provider Data Services.
  • Help to ensure functionality – particularly critical functionality – is available and reliable for users at all times.
  • Attend Dental Hub demonstrations as needed to support the adoption of the Provider Data Services.
  • Represent SKYGEN and the Dental Hub at industry events as appropriate.
  • Ensure Policies & Procedures are current and in compliance with relevant regulations and guidelines (including, but not limited to, NCQA and CMS requirements).
  • Collaborate with legal and business management teams to ensure the Dental Hub Terms of Use properly document the processes and payment requirements for each Provider Data Service.
• Provider Relations:
  • Oversee the development and implementation of provider outreach programs, the collection of provider feedback, and the resolution of escalated issues.
  • Serve as the voice of the provider within SKYGEN to advance organizational objectives.
  • Develop and monitor statistics to track provider usage of systems and individual performance.
  • Review and approve provider-training materials to ensure accuracy and thoroughness.
  • Work collaboratively with clients and the SKYGEN Client Experience team to develop and deliver strategic market-focused provider management programs.

What qualifications do YOU need to have to be GOOD candidate? 

• Education:
  • Bachelor's degree in Business Administration, Healthcare Management, or a related field, or equivalent work experience.
• Experience:
  • Minimum of 7+ years of experience in provider contracting, credentialing, and/or provider data and directory management.
  • 5+ years of experience in a management capacity.
  • Experience interacting with clients and managing teams.
• Knowledge, Skills, and Abilities:
  • Strong understanding of healthcare regulations and standards.
  • Strong understanding of NCQA and CMS guidelines and compliance requirements.
  • Excellent analytical and strategic thinking skills.
  • An innovative mindset.
  • Strong project management abilities, with experience in managing cross-functional teams.
  • Outstanding communication and interpersonal skills, with the ability to build relationships and influence stakeholders at all levels.
  • Proficiency in MS Office Suite (Excel, PowerPoint, Word) and familiarity with product management software and tools.

What qualifications do YOU need to have to be GREAT candidate? 

• Education:
  • Master's degree in Business Administration or similar field.
• Experience:
  • Experience with diverse network development and contracting strategies, network lease arrangements and network stacking
  • Experience with contracting strategies to support risk shifting arrangements from shared to full risk scenarios
  • Experience with dental, medical, vision, and/or healthcare administration.
  • More than 5 years of experience in a management capacity.
• Knowledge, Skills, and Abilities:
  • Knowledge of Enterprise Systems.
  • Experience developing and implementing training and quality assurance programs.
  • Experience managing through change efforts.

Compensation Range:

Compensation Midpoint: