[Remote] Provider Relations Representative I - Mississippi

Note: The job is a remote job and is open to candidates in USA. Avēsis is a leading provider of supplemental benefits, and they are seeking a Provider Relations Representative I to act as a liaison between the company and its network of dental care providers. The role involves building and maintaining relationships, delivering provider education, and resolving provider issues to ensure high-quality service delivery.

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
• 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
• Consistently document all provider interactions, including calls, emails, virtual 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
• Owns and manages relationship and performance of assigned provider groups. Serves as the primary point of contact for assigned providers
• Complete provider orientation via phone, email, or virtually for all applicable product lines to train, resolve issues, and educate staff/providers
• 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 changes of provider demographic related database information
• 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

Skills

• Must reside in the state of Mississippi
• High School diploma or equivalent
• Comprehension of Medical/Dental Terminology
• Previous Dental office administration experience
• The ability to travel 10-20% to attend trade shows required
• 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 25 Mbps upload while hardwired and not on a VPN are sufficient
• Knowledge of dental health plan operations preferred
• Knowledge of dental provider/health plan contracts/agreements highly desired
• Microsoft applications and other windows-based applications to include an intermediate level in Microsoft Excel and databases

Benefits

• This role may also be eligible for benefits, bonuses, and commission.
• 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.

Company Overview