Credentialing Specialist II

Avesis

21h • Remote

About The Position

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. In this role, you’ll 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, skills.
• data entry skills.
• clerical skills.
• 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.
• Perform 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.

What This Job Offers

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