Provider Relations Field Representative II

Avēsis

. Conduct provider outreach through in-person, video, phone, and email training, orientation, and coaching .

Posted 10/23/2026full-timeRemote • Pennsylvania • United StatesJunior💰 $46,080 - $90,080 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in provider outreach, claims submission, and provider credentialing processes while effectively managing relationships and performance of assigned provider groups. Proficient in analyzing provider network metrics and operational trends to enhance network adequacy and performance.

Highest-signal resume keywords

Provider OutreachClaims SubmissionProvider CredentialingHealth Plan OperationsData Analysis

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Dental TerminologyProvider ContractingNetwork Adequacy EvaluationProvider Performance MonitoringData Analysis Systems

Soft Skills

CoachingMentoringCommunication

Tools & Technologies

Microsoft OfficeMicrosoft Excel

Certifications & Qualifications

DANB CertificationCDA Certification

Industry Keywords

Health Insurance ClaimsProvider CapacityOperational EffectivenessProvider EducationState Programs

About the role

Key responsibilities & impact

Conduct provider outreach through in-person, video, phone, and email training, orientation, and coaching
Provide guidance on eligibility confirmation, claims submission, and payment tools
Conduct monthly and/or quarterly provider group meetings and document issues, attendees, and action items
Research claims or prior authorization issues and route them for resolution
Collaborate with Network Recruitment on provider contracting, inquiry response, and network adequacy reviews
Collaborate with Credentialing on document intake and provider credentialing inquiries
Own relationships and performance of assigned provider groups as primary point of contact
Document provider interactions, outreach, office visits, concerns, and issue resolution
Communicate provider claims and directory reporting internally and externally
Complete provider orientation across applicable product lines
Support adoption of provider tools, portals, and digital processes
Perform onsite facility reviews and quarterly face-to-face visits within the assigned territory
Coordinate with Claims, Customer Service, Utilization Management, Clinical Management, Credentialing, Recruitment, and Account Management teams
Educate providers on state programs, group policies, health plan policies, procedures, and regulations
Investigate complex provider issues and update provider demographic database information
Respond to contract inquiries, provider education requests, and non-routine claim issues
Maintain accurate and timely records for reporting and operational effectiveness
Attend work-related events and conferences as an organizational representative
Coach and mentor junior team members as applicable

Requirements

What you’ll need

Must live in or be in close proximity to Pennsylvania
High School Diploma or equivalent
1 to 2 years of Dental office experience
Comprehension of Dental Terminology
Intermediate knowledge of Microsoft Office applications, especially Microsoft Excel, including spreadsheets, databases, word processing, presentation software and data analysis systems
Valid driver's license with proof of auto insurance and ability to use own vehicle
Ability to travel up to 50% in Pennsylvania
Maintain internet service with at least 25 Mbps download and 25 Mbps upload while hardwired and not on a VPN
Knowledge of health plan operations
Knowledge of provider/health plan contracts and agreements
Ability to monitor provider capacity, performance, and network adequacy
Ability to evaluate provider performance and network adequacy metrics
Ability to analyze provider network composition, geographic access, and market conditions
Ability to identify recurring provider issues and operational trends
Bachelor's degree preferred
DANB or CDA certification preferred
1 year experience with provider credentialing and contracting process preferred
1 to 2 years of health insurance claims experience and ability to analyze data to resolve provider claim issues preferred

Benefits

Comp & perks

Skill-building, leadership development and philanthropic opportunities
Medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period
Life and disability insurance
401(k) with company match
Tuition assistance
Paid parental leave
Backup family care
Flexible time off
Flexible dress code and work location policies
Employee Resource Groups
Social responsibility and community volunteer opportunities
Benefits, bonuses, and commission may be available