Provider Relations Representative II - Dental

Provider Relations Representative II - Dental - Chicago Work From Home Full time job requisition id JR1289 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. At Avesis, the Provider Relations Representative plays a vital role in connecting our dental 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 dental care to our members, while also supporting and nurturing the growth of our provider community. Join us in making a meaningful impact on 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. You will lead efforts to foster the best-in-class provider education, tackle provider inquiries and issues, and manage a variety of initiatives that enhance our relationships with the provider network. Our chosen candidate must reside within the city of Chicago or near suburbs due to the travel component of this role. Functional Competencies:

• 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.

Core Competencies:

• Knowledge of health plan operations preferred.
• Knowledge of provider/health plan contracts/agreements highly desired.
• Microsoft applications and other windows-based applications to include an intermediate level in Microsoft Excel and databases. Knowledge of and intermediate ability to use various computer programs such as Microsoft Office including spreadsheets, databases, word processing and presentation software and programs/systems utilized in data analysis.
• 1 years’ experience with provider credentialing and contracting process preferred.
• 1 to 2 years of health insurance

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