Provider Relations Field Representative - Dallas/Fort Worth

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

Our 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.

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. The Provider Relations Representative will be responsible for coordinating efforts to build and nurture positive relationships with the Avesis vision 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 team members as applicable.
• Demonstrating a collaborative approach to problems–solving by successfully working with and effectively communicating with other areas (account management, utilization management, provider services).
• Other duties as assigned.

Requirements:

• High School Diploma or equivalent required: Bachelor’s Degree preferred. 
• 50% local travel around the Dallas/Fort Worth area required. *See below.
• 1 year of vision office experience required.  
• Comprehension of Medical/Vision Terminology required. 
• Certified Ophthalmic Assistant, Certified Ophthalmic Technician, and Certified Ophthalmic Medical Technician preferred.
• 1 year 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. 
• Knowledge of health plan operations preferred.
• Knowledge of 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, data bases, word processing and presentation software and programs/systems utilized in data analysis. 
• 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 25 Mbps upload while hardwired and not on a VPN are sufficient.

A valid driver's license with proof of auto insurance and the ability to use your own vehicle is required. The ability to travel up to 50% is required to meet prospective clients, existing customers, attend trade shows and other meetings as needed.  Travel requirements may vary at different times of the year and can range from short/overnight trips to extended stays, visiting different regions to oversee project/client implementation or to provide guidance to our customers.  Modes of transportation may also include public transportation, such as rail, bus, car and/or plane.  Travel/mileage reimbursement will be provided in alignment with the IRS annual mileage program and/or receipts submitted through the company expense report policy.

FLSA Status:  Salary/Exempt
National Salary Range:  $46,080 - $61,440

How to stay safe:
Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.
Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam).  If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

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 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.

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

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