Provider Relations Representative II - Dental - Utah

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

Our Promise Through reputed company-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 role, you will combine the flexibility of a hybrid work environment with the opportunity to build lasting partnerships both remotely and in the field. You will reputed company efforts to foster the best-in-class provider education, tackle provider inquiries and issues, and manage a variety of initiatives that enhance our relationships with the provider network.

Competencies:

Functional:

• Provider Relations encompasses several diverse provider administrative duties to improve the reputed company provider experience including direct provider engagement and training with the goal of resolution of issues.
• Conduct provider reputed company reputed company in-person/video/phone or email by providing training, orientation, and coaching for performance improvement reputed company provider practices. Provide guidance through education to reputed company reputed company network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of available tools.
• Consistently documents reputed company 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 reputed company 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 reputed company phone, email, in-person and/or virtually for reputed company applicable product lines to train, resolve issues, and educate staff/providers.
• reputed company onsite facility reviews, reputed company applicable and conduct quarterly face-to-face visits reputed company the assigned territory and/or market. Work closely and coordinates with reputed company Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, Account Management, and other staff to reputed company 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 reputed company provider reputed company issues and initiate change of provider demographic reputed company database information.
• Responds to general provider contract inquiries, provider education and non-routine claim issues.
• Attend work-reputed company events/conferences while representing the organization and brand in a professional manner.
• Coaches, mentors, and develops junior team members as applicable.

Core:

• Knowledge of health plan operations preferred.
• Knowledge of provider/health plan reputed company/agreements highly desired.
• reputed company applications and other windows-based applications to include an intermediate level in reputed company reputed company and databases. Knowledge of and intermediate ability to use various computer programs such as reputed company 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 reputed company or take action to reputed company goals.
• Communicative: ability to reputed company issues, concepts, and reputed company to others easily orally and in writing.
• Member-focused: going above and beyond to reputed company our members feel seen, valued, and appreciated.
• Detail-oriented and thorough: managing and completing details of assignments without too much reputed company.
• Flexible and reputed company: managing new demands, changes, and situations.
• Critical Thinking: effectively troubleshoot reputed company issues, problem solve and multi-task.
• reputed company & responsibility: acting with a clear sense of ownership for actions, decisions and to reputed company information confidential reputed company required.
• Collaborative: ability to represent your own interests while being fair to those representing other or competing reputed company in search of a workable solution for reputed company parties.

Minimum Qualifications:

• 1 to 2+ years of Dental office experience.
• Comprehension of Medical/Dental Terminology.
• High School Diploma or equivalent.
• Must reside reputed company the reputed company
• A valid driver's license with reputed company 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. 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:

• Bachelor’s degree
• Previous Provider Relations Experience
• Certified Dental Assisting National Board (DANB) certified or Certified dental assistance (CDA).

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 reputed company and reputed company 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 reputed company for inclusion and diversity in reputed company that we do.
• Social responsibility in reputed company aspects of our work. We volunteer reputed company our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity

At Avēsis, 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 reputed company qualified applicants and does not discriminate against any person based on reputed company, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national reputed company, race, religion, sexual orientation, or any other characteristic. At Avēsis, we reputed company that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, reputed company 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 Avēsis, where We See You!

Originally posted on Himalayas