Dental Provider Relations Field Representative - Cook County (Chicago), Illinois

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The Provider Relations Field Representative is tasked as part of the Provider Relations Department to be the liaison between Avesis and the participating provider network. Our chosen candidate will be responsible for coordinating efforts to build and nurture positive relationships with the Avesis dental provider community to include but not limited to best-in-class provider education and training, issues research and projects. The Provider Relations Field Representative role is a hybrid position which will include remote office and field travel to support provider network relationships and initiatives.

Essential Job Functions: 

• Provider Operations 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 via in-person/video/phone or email by providing training, orientation, and coaching for performance improvement within provider practices. Provide 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.
• Owns and manages relationship and performance of assigned provider groups. Serves as the primary point 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 via phone, email, in-person and/or virtually for all applicable product lines to train, resolve issues, and educate staff/providers.
• Perform onsite facility reviews, when applicable and conduct quarterly face-to-face 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.
• 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 complex provider related issues and initiate change of provider demographic related database information.
• Responds to general provider contract inquiries, provider education and non-routine claim issues.
• Attend work-related events/conferences while representing the organization and brand in a professional manner.
• Coaches, mentors, and develops junior …