Provider Relations Representative I - Mississippi

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Join us for an exciting career with the leading provider of supplemental benefits! O ur 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. At Avesis, The Provider Relations Representative I plays a pivotal role within Avesis, acting as the essential liaison between the company and its network of participating vision care providers. As a member of the Provider Relations Department, the Provider Relations Representative is responsible for building and maintaining strong, positive relationships with providers to ensure seamless collaboration and high-quality service delivery. As the face of Avesis to the provider community, the PR1 ensures that both Avesis and its network of providers operate in sync to deliver exceptional vision care to members. This is a fantastic opportunity to make a meaningful impact, work with diverse healthcare professionals, and contribute to the growth and success of a thriving organization. If you're passionate about relationship-building, problem-solving, and driving excellence in healthcare, this role is for you. 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. ***Candidates must reside in the state of Mississippi, per contractual requirements. Functional Competencies: 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 on site and routing to the appropriate party for resolution. Consistently document 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. Work in conjunction with Provider Relations Representative II to ensure that provider concerns are addressed (as applicable) 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 changes of provider demographic related database information. 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 Core Competencies: Knowledge of dental health plan operations preferred. Knowledge of dental 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. Behavioral Competencies: 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 writin

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