Avēsis is a leading provider of supplemental benefits, seeking a Provider Relations Representative II to connect their dental provider community with essential resources and support. This role involves fostering relationships, conducting provider education, and managing provider inquiries to ensure high-quality dental care delivery.
Responsibilities
- Provider Relations encompasses several diverse provider administrative duties to improve the Avesis provider experience including direct provider engagement and training with the goal of resolution of issues
- Conduct provider outreach via in-person/video/phone or email by providing training, orientation, and coaching for performance improvement within provider practices. Provide guidance through education to enable Avesis network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of available tools
- Consistently documents all provider interactions, including calls, emails, virtual and in-person visits, in accordance with departmental standards. Ensures that notes are clear, timely, and accurately reflect the nature of the communication to support ongoing relationship management, issue resolution, and continuity of service across teams
- Maintains thorough and timely records to ensure accountability, transparency, and effective information sharing across teams
- Conduct monthly and/or quarterly meetings with provider groups documenting discussions, issues, attendees, action items, researching claims or prior authorization issues on site and routing to the appropriate party for resolution
- Owns and manages relationship and performance of assigned provider groups. Serves as the primary point of contact for assigned providers
- Communicate and shares provider claims and directory reporting both internally and externally and additional reporting as necessary
- Complete provider orientation via phone, email, in-person and/or virtually for all applicable product lines to train, resolve issues, and educate staff/providers
- Perform onsite facility reviews, when applicable and conduct quarterly face-to-face visits within the assigned territory and/or market. Work closely and coordinates with Avesis Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, Account Management, and other staff to develop operational solutions for various provider network projects
- Educate providers regarding state program, group policies, and/or health plan policies and procedures and state/federal regulation for compliance requirements. Investigate and respond to complex provider related issues and initiate change of provider demographic related database information
- Responds to general provider contract inquiries, provider education and non-routine claim issues
- Attend work-related events/conferences while representing the organization and brand in a professional manner
- Coaches, mentors, and develops junior team members as applicable
Skills
- High School Diploma or equivalent
- 1 to 2+ years of Dental office experience
- Comprehension of Medical/Dental Terminology
- Must reside within the state of Kentucky
- A valid driver's license with proof of auto insurance and the ability to use your own vehicle
- The ability to travel up to 50% is required to meet prospective clients, existing customers, attend trade shows and other meetings as needed
- As this role is a remote role, you are required to maintain internet service that allows you to complete your essential job duties without issue. Rates of 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient
- Bachelor's degree
- Previous Provider Relations Experience
- Dental Assisting National Board (DANB) certified or Certified dental assistance (CDA)
- 1 year of experience with provider credentialing and contracting processes
- 1 year of dental insurance claim experience, as well as the ability to analyze data to resolve provider claim issues
Benefits
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
Company Overview
Guiding you to wellness with innovative tools, equitable access, and a personal touch. It was founded in 1978, and is headquartered in Phoenix, AZ, US, with a workforce of 501-1000 employees. Its website is http://www.avesis.com.
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