Provider Relations Field Representative II

🔥 2 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $46.1k - $90.1k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Avēsis

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1978

🛡️ Insurance

⚕️ Healthcare Insurance

🧘 Wellness

Insurance • Healthcare Insurance • Wellness

Avēsis is a company dedicated to providing comprehensive specialty benefits focused on improving access, equity, and health outcomes. Specializing in dental and vision plans, Avēsis offers flexible, affordable, and outcome-focused oral health benefits as well as vision plans that connect eye health to overall well-being. With over 40 years of experience, Avēsis is committed to personalized care and building community health networks to service government partners, commercial providers, employers, and brokers. Avēsis operates as a wholly owned subsidiary of Guardian, and leverages tailored network and product solutions to deliver accessible quality care to members, while also administering Medicaid, Medicare, and other essential benefits programs.

📋 Description

• Conduct provider outreach through in-person, video, phone, and email training, orientation, and coaching • Provide guidance on eligibility confirmation, claims submission, and payment tools • Conduct monthly and/or quarterly provider group meetings and document issues, attendees, and action items • Research claims or prior authorization issues and route them for resolution • Collaborate with Network Recruitment on provider contracting, inquiry response, and network adequacy reviews • Collaborate with Credentialing on document intake and provider credentialing inquiries • Own relationships and performance of assigned provider groups as primary point of contact • Document provider interactions, outreach, office visits, concerns, and issue resolution • Communicate provider claims and directory reporting internally and externally • Complete provider orientation across applicable product lines • Support adoption of provider tools, portals, and digital processes • Perform onsite facility reviews and quarterly face-to-face visits within the assigned territory • Coordinate with Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, and Account Management teams • Educate providers on state programs, group policies, health plan policies, procedures, and regulations • Investigate complex provider issues and update provider demographic database information • Respond to contract inquiries, provider education requests, and non-routine claim issues • Maintain accurate and timely records for reporting and operational effectiveness • Attend work-related events and conferences as an organizational representative • Coach and mentor junior team members as applicable

🎯 Requirements

• Must live in or be in close proximity to Pennsylvania • High School Diploma or equivalent • 1 to 2 years of Dental office experience • Comprehension of Dental Terminology • Intermediate knowledge of Microsoft Office applications, especially Microsoft Excel, including spreadsheets, databases, word processing, presentation software and data analysis systems • Valid driver's license with proof of auto insurance and ability to use own vehicle • Ability to travel up to 50% in Pennsylvania • Maintain internet service with at least 25 Mbps download and 25 Mbps upload while hardwired and not on a VPN • Knowledge of health plan operations • Knowledge of provider/health plan contracts and agreements • Ability to monitor provider capacity, performance, and network adequacy • Ability to evaluate provider performance and network adequacy metrics • Ability to analyze provider network composition, geographic access, and market conditions • Ability to identify recurring provider issues and operational trends • Bachelor's degree preferred • DANB or CDA certification preferred • 1 year experience with provider credentialing and contracting process preferred • 1 to 2 years of health insurance claims experience and ability to analyze data to resolve provider claim issues preferred

🏖️ Benefits

• Skill-building, leadership development and philanthropic opportunities • Medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period • Life and disability insurance • 401(k) with company match • Tuition assistance • Paid parental leave • Backup family care • Flexible time off • Flexible dress code and work location policies • Employee Resource Groups • Social responsibility and community volunteer opportunities • Benefits, bonuses, and commission may be available