Provider Relations Field Representative II - Pennsylvania

Join us for an exciting career with the leading provider of supplemental benefits! Our Promise Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards. ***To be considered for this role, you MUST live in or be in close proximity to the state of Pennsylvania.*** At Avesis, the Provider Relations Representative, II plays a vital role in connecting our vision provider community with the resources, education, and support they need to thrive. As a key member of our Provider Relations Department, you’ll be the bridge between Avesis and our participating provider network, ensuring that our partners are equipped, informed, and engaged every step of the way. If you’re a self-driven communicator who thrives on building relationships and solving problems, this is the role for you. Your expertise and passion will directly contribute to Avesis’s mission of delivering high-quality, accessible vision care to our members, while also supporting and nurturing the growth of our provider community. Join us in making a meaningful impact in the healthcare space! In this role, you will combine the flexibility of a hybrid work environment with the opportunity to build lasting partnerships both remotely and in the field. Functional Competencies Provider Operations 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. Conducts 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. 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. Collaborate with the Network Recruitment team to manage provider contracting for assigned providers, including intake of contracting requests, prompt inquiry response, and network adequacy reviews to ensure organizational and regulatory compliance. Collaborate with the Credentialing team to manage provider credentialing for assigned providers, including document intake and prompt inquiry response. Owns and manages relationships and performance of assigned provider groups. Serves as the primary point of contact for assigned providers. Documents provider interactions, outreach activities, office visits, provider concerns, and issue resolution activities in accordance with departmental standards. 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. Support provider adoption of tools, portals, and digital processes that improve administrative efficiency, directory accuracy, and electronic transaction performance. Perform onsite facility reviews, when applicable and conduct quarterly face-to-face visits within the assigned territory and/or market. Work closely and coordinate 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 regulations 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. Maintains accurate and timely records to support accountability, reporting requirements, operational effectiveness, and cross-functional communication. Attend work-related events/conferences while representing the organization and brand in a professional manner. Coaches, mentors, and develop junior team members as applicable. Core Competencies Knowledge of health plan operations. Knowledge of provider/health plan contracts/agreements. Ability to monitor provider capacity, performance, and network adequacy within assigned markets and identify opportunities to improve member access to care. Ability to evaluate provider performance and network adequacy metrics, identify systemic gaps, and partner cross-functionally to implement solutions that enhance access to care, provider engagement, and overall network effectiveness. Ability to analyze provider network composition, geographic access, and market conditions to identify opportunities for recruitment, network expansion, and improved provider coverage. Ability to identify recurring provider issues and operational trends, elevate concerns appropriately, and support implementation of corrective actions. Behavioral: Collegiality: building strong relationships company-wide, approachable, and helpful, ability to mentor and support team growth. Behavioral: Initiative: readiness to lead or take action to achieve goals. Behavioral: Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing. Behavioral: Member-focused: going above and beyond to make our members feel seen, valued, and appreciated. Behavioral: Detail-oriented and thorough: managing and completing details of assignments without too much oversight. Behavioral: Flexible and responsive: managing new demands, changes, and situations. Behavioral: Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task. Behavioral: Integrity & responsibility: acting with a clear sense of ownership for actions and decisions and to keep information confidential when required. Behavioral: Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties. Minimum Qualifications High School Diploma or equivalent. 1 to 2 years of Dental office experience. Comprehension of Dental Terminology. Intermediate level knowledge of Microsoft Office applications and other windows-based applications focusing on Microsoft Excel, including spreadsheets, databases, word processing, presentation software and programs/systems utilized in data analysis. 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% in Pennsylvania is required to meet prospective clients, existing customers, attend trade shows and other meetings as needed. Travel times may vary and can range from short overnight trips to extended stays. 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 25 Mbps download and 25 Mbps upload while hardwired and not on a VPN are sufficient. Preferred Qualifications Bachelor’s degree Certified Dental Assisting National Board (DANB) certified or Certified dental assistance (CDA). 1 year experience with provider credentialing and contracting process. 1 to 2 years of health insurance claims, as well as ability to analyze data to resolve provider claim issues. Compensation At Avēsis, we strive to design equitable, and competitive compensation programs. Base pay within the range is ultimately determined by a candidate's skills, expertise, or experience. In the United States, we have three geographic pay zones. Zone A: $46,080.00-$76,800.00 Zone B: $50,220.00-$83,700.00 Zone C: $54,050.00-$90,080.00 FLSA Status: Salary/Exempt This role may also be eligible for benefits, bonuses, and commission. Benefits Competitive compensation package. 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. Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent. Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best. Employee Resource Groups that advocate for inclusion and diversity in all that we do. Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability. Equal Employment Opportunity At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You! About Avēsis Avēsis has been providing essential ancillary benefit solutions since 1978. Since its inception Avēsis has developed, administered and refined its offerings to provide clients with best-in-class product choices and services. Today, our programs cover more than 8.5 million members throughout the country. We strive for excellence in all that we do and our benchmark performance in terms of member satisfaction and client retention underscores this singular focus. #J-18808-Ljbffr Avesis Incorporated