Provider Relations Solution Specialist

Avesis

1d • Remote

About The Position

The Provider Relations Resolution Specialist plays a critical role in ensuring the effective resolution of complex dental and vision claims while supporting provider credentialing efforts through proactive outreach and document collection. This position requires strong analytical and problem-solving skills, attention to detail, and the ability to communicate clearly and professionally with providers and internal stakeholders. The ideal candidate brings experience in dental or vision claims, a collaborative and team-oriented mindset, and a passion for enhancing the provider experience within a growing and innovative organization.

Requirements

• 2+ years of experience in dental or vision claims resolution, medical billing, or provider credentialing support.
• Comprehension of Dental or Vision Terminology.
• High School Diploma or equivalent.
• 2+ years of experience in document management, technical writing, provider relations, or a similar role
• 1+ years of experience Microsoft Office applications, including Word, PowerPoint and Excel including data analysis and spreadsheet management
• Familiarity with workflow or project management platforms, such as Smartsheet or similar systems
• Strong ability to learn and use additional software programs and systems for data analysis and reporting
• Familiarity with credentialing platforms (e.g., CAQH) and payer portals (e.g., Availity)
• 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 25 Mbps upload while hardwired and not on a VPN are sufficient.

Nice To Haves

• Bachelor’s degree in business administration, Communications, Healthcare Administration, or a related field (or equivalent experience).
• 2+ years of Provider Relations or Member Engagement experience
• Knowledge of health plan operations preferred.
• Knowledge of provider/health plan contracts/agreements highly desired.
• Ability to accurately document 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
• Excellent written and verbal communication skills with strong attention to detail.
• Ability to manage multiple projects simultaneously and meet deadlines.
• 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 and 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.

Responsibilities

• Investigate and resolve complex dental and vision claims by working with payers, providers, and internal teams.
• Conduct monthly root cause analysis on recurring claim issues and recommend process improvements.
• Accountable for research and resolution of claims check trace requests for both in and out of network providers, accountable for the end-to-end process while collaborating with internal stakeholders.
• Partner with multiple cross-functional departments and vendors to resolve claims issues timely and efficiently.
• Maintain accurate documentation of claim activity and resolution steps in internal systems.
• Demonstrates ownership of individual responsibilities while actively contributing to the overall success of the Provider Relations team.
• Supports achievement of departmental operational, quality, and performance KPIs through consistent execution, collaboration, and accountability.
• Responds to inquiries within 3 business days, provide education and may research, analyze, and recommend resolution updates to assist with provider confusion or disputes.
• Ability to prioritize and organize a diverse workload required.
• Assist in the collection of and verification of credentialing documentation from providers and facilities assigned to the Provider Relations Department.
• Regularly conducting outreach via phone and email to obtain missing or updated documents.
• Track outstanding credentialing items and follow up weekly to ensure timely submission.
• Support credentialing compliance by maintaining accurate and up-to-date provider records.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED