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Avēsis · 1 week ago

Provider Relations Representative II - Vision - Kentucky

Kentucky, United States

Full-time

Hybrid

Entry, Mid Level

$46K/yr - $77K/yr

2+ years exp

Avēsis is a leading provider of supplemental benefits, and they are seeking a Provider Relations Representative II to connect their vision provider community with essential resources and support. The role involves managing relationships with providers, conducting outreach and education, and addressing inquiries to enhance provider engagement and performance.

Insurance

Hiring Manager

Cathy Barry

Responsibilities

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

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 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

Qualification

Provider RelationsHealth plan operationsMicrosoft ExcelClaims experienceOptometry experienceCoachingCommunicationProblem-solving

Required

High School Diploma or equivalent required

Must reside in the state of Kentucky

2+ years of Optometry or Ophthalmology office experience required

Comprehension of Vision industry claim terminology

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. 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 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient