Provider Relations Field Representative II - Pennsylvania

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. To be considered for this role, you MUST live in or be in close proximity to the state of Pennsylvania. At Avesis, the Provider Relations Representative (PR2) plays a vital role in connecting our vision provider community with the resources, education, and support they need to thrive.

As a key member of our Provider Relations Department, you’ll be the bridge between Avesis and our participating provider network, ensuring that our partners are equipped, informed, and engaged every step of the way. If you’re a self-driven communicator who thrives on building relationships and solving problems, this is the role for you. Your expertise and passion will directly contribute to Avesis’s mission of delivering high-quality, accessible vision care to our members, while also supporting and nurturing the growth of our provider community.

Join us in making a meaningful impact in the healthcare space! In this role, you will combine the flexibility of a hybrid work environment with the opportunity to build lasting partnerships both remotely and in the field.

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. Collaborate with the Network Recruitment team to manage provider contracting for assigned providers, including intake of contracting requests, prompt inquiry response, and network adequacy reviews to ensure organizational and regulatory compliance.

Collaborate with the Credentialing team to manage provider credentialing for assigned providers, including document intake and prompt inquiry response. Owns and manages relationships and performance of assigned provider groups. Serves as the primary point of contact for assigned providers. Documents provider interactions, outreach activities, office visits, provider concerns, and issue resolution activities in accordance with departmental standards. 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. Support provider adoption of tools, portals, and digital processes that improve administrative efficiency, directory accuracy, and electronic transaction performance. Perform onsite facility reviews, when applicable and conduct quarterly face-to-face visits within the assigned territory and/or market. Work closely and coordinate 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 regulations 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. Maintains accurate and timely records to support…