Provider Relations Solution Specialist

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.

Claims Resolution & Research (Primary 70%)

• 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.

Credentialing Document Outreach (Secondary 30%)

• 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.

Core:

• 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.

Behavioral:

• 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.

Minimum Qualifications:

• 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.

Preferred Qualifications:

• 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

Equal Employment Opportunity

At Avsis, 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 Avsis, 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 Avsis, where We See You!

At Avsis, we strive to design equitable, and competitive compensation programs. Base pay within the range is ultimately determined by a candidate's skills, expertise, or experience. In the United States, we have three geographic pay zones. For this role, our current pay ranges for new hires in each zone are:

This role may also be eligible for benefits, bonuses, and commission.

Please visit Avesis Pay Zones for more information on which locations are included in each of our geographic pay zones. However, please confirm the zone for your specific location with your recruiter.

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.

How To Stay Safe

Avsis is aware of fraudulent activity by individuals falsely representing themselves as Avsis 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.

Avsis 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 our process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avsis recruiters will come from a verified email address ending in @ Avsiscom.

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. Avsis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

Equal Employment Opportunity

At Avsis, 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 Avsis, 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 Avsis, where We See You!