Credentialing Specialist II

Avesis

1d • $17 - $33 • Remote

About The Position

In this role as Credentialing Specialist II, you'll play a crucial role in ensuring our network of healthcare providers meets the highest standards of quality and professionalism. You’ll be responsible for processing provider applications for credentialing and re-credentialing, maintaining compliance with state, federal, and NCQA guidelines, and ensuring smooth, efficient operations within the team. If you thrive in a fast-paced environment and have a keen eye for detail, this is your chance to make a real impact while developing your career in a critical area of healthcare operations.
Job Summary: You will be the gatekeeper for ensuring our healthcare partners meet regulatory requirements and industry best practices, directly impacting the quality of care delivered to patients. You’ll work closely with cross-functional teams to ensure provider data is accurate, up-to-date, and compliant. Your work helps shape a trusted network of healthcare providers, ensuring patients receive care from credentialed and qualified professionals.

Requirements

• Working knowledge of NCQA standards and payer credentialing standards.
• Knowledge of vision, dental or hearing industry.
• Strong computer, data entry and clerical skills.
• 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, 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.
• Associate degree or equivalent combination of education and experience.
• 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 Mbps upload while hardwired and not on a VPN are sufficient.
• 3 years credentialing experience, preferably in a managed care setting.

Nice To Haves

• CPCS certified

Responsibilities

• Facilitate provider onboarding efforts including but not limited to importing data from CVO into applicable systems, ensuring required documentation is complete and accurate, ensure all submitted documentation aligns with industry and organizational standards.
• Performs timely follow-up with providers on pending applications/information
• Perform primary source verifications according to the departmental policies and NCAQ standards when not completed by CVO.
• Builds and accurately maintains provider information in various systems
• Responds to inquiries regarding the status of provider’s application
• Utilizes organizational templates to communicate with providers about the status of their application with the organization
• Provides support to Credentialing Specialist I on functional responsibilities.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree