Provider Relations Field Representative II - Pennsylvania

Avesis•Work From Home - PA, PA

2d•$46,080 - $90,080•Remote

About The Position

The Provider Relations Field Representative II connects Avesis’s vision provider community with resources, education, and support. The role serves as the primary contact for assigned provider groups, builds and manages provider relationships, and helps providers improve performance and administrative efficiency. It combines remote work with field visits and requires residence in or close proximity to Pennsylvania. The representative provides provider orientation, training, coaching, and issue resolution; supports contracting and credentialing processes; reviews provider performance and network adequacy; and coordinates with internal teams to address provider and operational needs. The role also maintains timely documentation and reporting, supports adoption of digital tools, represents Avesis at events, and may coach junior team members. The position requires travel up to 50% within Pennsylvania, including visits to providers and other meetings. The role is remote and requires reliable internet service, with at least 25 Mbps download and upload while hardwired and not using a VPN.

Requirements

High school diploma or equivalent.
1 to 2 years of dental office experience.
Comprehension of dental terminology.
Intermediate knowledge of Microsoft Office and other Windows-based applications, particularly Microsoft Excel, spreadsheets, databases, word processing, presentation software, and systems used for data analysis.
Valid driver's license, proof of auto insurance, and ability to use a personal vehicle.
Ability to travel up to 50% in Pennsylvania; travel may include overnight trips or extended stays.
Must live in or close proximity to Pennsylvania.
Maintain internet service adequate for essential job duties; 25 Mbps download and 25 Mbps upload while hardwired and not on a VPN are sufficient.
Knowledge of health-plan operations and provider/health-plan contracts or agreements.
Ability to evaluate provider performance and network adequacy, analyze provider-network composition and geographic access, and identify opportunities to improve access and network effectiveness.
Strong relationship-building, communication, initiative, member focus, attention to detail, flexibility, critical thinking, integrity, and collaboration skills.

Nice To Haves

Bachelor’s degree.
Certified Dental Assisting National Board (DANB) certification or Certified Dental Assistant (CDA) qualification.
1 year of experience with provider credentialing and contracting processes.
1 to 2 years of health insurance claims experience and ability to analyze data to resolve provider claim issues.

Responsibilities

Conduct provider outreach by in-person, video, phone, or email to provide training, orientation, and performance-improvement coaching.
Educate providers on eligibility verification, claims submission and payment processes, available tools, and relevant program, group, health-plan, and regulatory requirements.
Hold monthly and/or quarterly meetings with provider groups, document discussions and action items, and research and route claims or prior-authorization issues for resolution.
Collaborate with Network Recruitment on assigned provider contracting, including intake of requests, inquiry responses, and network adequacy reviews.
Collaborate with Credentialing on assigned provider credentialing, including document intake and inquiry responses.
Own relationships and provider performance for assigned groups and serve as their primary point of contact.
Document provider interactions, outreach, visits, concerns, and issue-resolution activities according to departmental standards.
Share provider claims and directory reporting internally and externally, and provide additional reporting as needed.
Support adoption of tools, portals, and digital processes that improve administrative efficiency, directory accuracy, and electronic transaction performance.
Conduct onsite facility reviews when applicable and quarterly face-to-face visits within the assigned territory or market.
Coordinate with Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, Account Management, and other staff to develop operational solutions for provider-network projects.
Investigate and respond to complex provider issues, general contract inquiries, provider education needs, and non-routine claim issues; initiate updates to provider demographic information in databases.
Maintain accurate and timely records for accountability, reporting, operational effectiveness, and cross-functional communication.
Attend work-related events and conferences while representing the organization professionally.
Coach, mentor, and develop junior team members as applicable.
Monitor provider capacity, performance, and network adequacy; analyze network and market conditions to identify access, recruitment, and coverage opportunities.
Identify recurring provider issues and operational trends, escalate concerns, and support corrective actions.

Benefits

Medical, dental, supplemental health, life, and vision coverage for employees and dependents, with no waiting period.
Life and disability insurance.
401(k) with company match.
Tuition assistance.
Paid parental leave.
Backup family care.
Flexible time off.
Flexible work-location policies.
Competitive compensation; role may also be eligible for benefits, bonuses, and commission.
Dynamic, modern work environments that promote collaboration and creativity.
Employee Resource Groups supporting inclusion and diversity.
Volunteer opportunities and sustainability initiatives.