Avēsis · 2 hours ago
Provider Relations Representative II, Dental - Mississippi
Mississippi, United States
Full-time
Hybrid
Entry, Mid Level
$46K/yr - $90K/yr
1+ years expAvēsis is a leading provider of supplemental benefits, and they are seeking a Provider Relations Representative to connect their dental provider community with essential resources and support. This role involves engaging with providers, conducting training, and managing relationships to ensure high-quality dental care delivery.
Insurance
Hiring Manager
Cathy Barry
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
Qualification
Required
High School Diploma or equivalent
1 to 2+ years of Dental office experience
Comprehension of Medical/Dental Terminology
Must reside within the state of Mississippi
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
Preferred
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.
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.
Company
Avēsis
Guiding you to wellness with innovative tools, equitable access, and a personal touch.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Sean Slovenski
Chief Executive Officer
Karim Bennis
Executive Vice President, Chief Operating Officer
Recent News
2024-01-03
2023-09-26
Company data provided by crunchbase