Melina Kesetovic

Provider Relations Representative @Avēsis

US

Provider Relations 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 remotely via phone/email/video by providing training, orientation, and coaching for performance improvement within provider practices. Provider 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.Act in a supportive role for the assigned provider territory (as applicable)Work in conjunction with Provider Relations Representative II to ensure that provider concerns are addressed (as applicable)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. Knowledge of the provider credentialing and contracting processEducate providers regarding state program, group policies, and/or health plan policies and procedures and state/federal regulation for compliance requirements.Investigate and respond to all provider related issues and initiate change of provider demographic related database information.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.Ability to analyze, prioritize and organize a diverse workload required.Excellent verbal and written communication and effective listening skills required.Other duties as assigned