Join us for an exciting career with the leading provider of supplemental benefits!

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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 (PR1) plays a pivotal role within Avesis, acting as the essential liaison between the company and its network of participating dental care providers. As a member of the Provider Relations Department, the PR1 is responsible for building and maintaining strong, positive relationships with providers to ensure seamless collaboration and high-quality service delivery.

As the face of Avesis to the provider community, the PR1 ensures that both Avesis and its network of providers operate in sync to deliver exceptional dental care to members. This is a fantastic opportunity to make a meaningful impact, work with diverse healthcare professionals, and contribute to the growth and success of a thriving organization. If you're passionate about relationship-building, problem-solving, and driving excellence in healthcare, this role is for you.

In this dynamic role, you will be responsible for delivering best-in-class provider education and training, ensuring providers are well-informed on processes, policies, and new initiatives. You'll also be a problem-solver, working to resolve provider issues, researching and addressing challenges, and leading key projects that enhance provider engagement and satisfaction.

Functional:

• 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.
• Conducts provider outreach remotely via phone/email/video by providing training, orientation, and coaching for performance improvement within provider practices. Provider 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.
• Act in a supportive role for the assigned provider territory (as applicable)
• Work in conjunction with Provider Relations Representative II to ensure that provider concerns are addressed (as applicable)
• 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.
• Knowledge of the provider credentialing and contracting process
• 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 all provider related issues and initiate change of provider demographic related database information.
• Knowledge of and intermediate ability to use various computer programs such as Microsoft Office including spreadsheets, data bases, word processing and presentation software and programs/systems utilized in data analysis

Core:

• Knowledge of health plan operations preferred.
• Knowledge of provider/health plan contracts/agreements highly desired.
• Strong skills in using Microsoft Office applications and other windows-based applications to include an intermediate level in Microsoft Excel and databases.

Behavioral:

• Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth. 
• Initiative: readiness to lead or take action to achieve goals.
• Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
• Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.
• Detail-oriented and thorough: managing and completing details of assignments without too much oversight.
• Flexible and responsive:  managing new demands, changes, and situations.
• Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.
• Integrity & responsibility:  acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.
• Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable