Provider Relations Representative I - Vision

Our Promise
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.

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.

Competencies:

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 and routing to the appropriate party for resolution.
• Consistently documents 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.
• Perform office visit/facility reviews, when applicable and conduct monthly and/or quarterly 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.
• 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.
• Microsoft applications and other windows-based applications to include an intermediate level in Microsoft Excel and databases. 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.
• 1 years' experience with provider credentialing and contracting process preferred.
• 1 to 2 years of health insurance claims, as well as ability to analyze data to resolve provider claim issues

preferred.

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 solution for all parties.

Minimum Qualifications:

• High School diploma or equivalent (Prefer associate degree or higher); experience may substitute for education.
• Comprehension of Medical/Vision Terminology.
• A valid driver's license with proof of auto insurance and the ability to use your own vehicle.
• The ability to travel 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.

Preferred Qualifications:

• Previous Provider Relations Experience
• Previous vision office administration experience.
• Certified Ophthalmic Assistant, Certified Ophthalmic Technician, and Certified Ophthalmic Medical Technician.
• Bachelor's degree

FLSA: Hourly/Non-Exempt

National Hourly Rate Range: $20.13 - $39.35

How to stay safe:

Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.

Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

We Offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• 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. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity

At Avsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avsis, where We See You!