Credentialing Supervisor

Avesis

9d • $55,790 - $109,040 • 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 as the Supervisor of Credentialing, you will lead and innovate within our Credentialing Department where you can drive operational excellence and compliance. As a key player in our organization, you will provide strategic direction and oversight to the Credentialing Specialists across all lines of business. In this role, you will assist in developing and implementing policies, procedures, and best practices that ensure efficient and compliant operations. This is your chance to make a meaningful impact on the healthcare industry while working in a flexible, forward-thinking environment. This is a vital role in supporting the integrity of our operations and ensuring that we provide the highest quality service to our members, providers, and stakeholders. In this critical role, your contributions will directly impact the quality of care that our members receive. By ensuring our providers meet stringent regulatory standards, you’ll help safeguard the organization against risk while supporting the ongoing success of our healthcare programs. Your work will have a tangible, positive impact on patient outcomes and provider relationships, and you'll play a key part in maintaining our company's reputation as a trusted healthcare partner. As the Supervisor of Credentialing, you’ll work to uphold rigorous standards, ensuring adherence to State and Federal regulations, National Committee for Quality Assurance (NCQA) standards, and other industry benchmarks. You will have direct responsibility for leading a team of Credentialing Specialists who carry out the day to day work to enroll providers in the Avesis provider networks. You’ll also have the opportunity to shape the future of provider data standards, process improvements, and team development, all while maintaining a culture of quality and compliance. As the Supervisor, you will be a guide to your team on credentialing processes and maintaining best-in-class practices to support Avesis’ continued growth and success. If you have a passion for healthcare compliance, a proven track record of leadership, and a strategic mindset, we want you to join our fully remote, dynamic team at Avesis.

Requirements

• Working knowledge of NCQA standards and payer credentialing standards.
• Working knowledge of best practices for provider data management and maintenance.
• Knowledge of PSV (primary source verifications), CAQH, OIG (Office of Inspector General) & NPDB (National Practitioner Data Bank).
• Working knowledge of credentialing databases to manage, track, and verify provider data.
• Strong computer, data entry and analysis 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.
• Bachelor's degree or equivalent education and experience
• CPCS Certification required, may be obtained within 6 months of accepting position
• 3+ years of credentialing experience in a managed care setting
• Intermediate skill level in Microsoft Excel
• 3+ years of experience managing and maintaining provider network databases.
• 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.

Nice To Haves

• Knowledge of vision or dental industry.
• 1-2 years leadership and performance management experience

Responsibilities

• Lead a first-class, metrics-driven credentialing operation maintaining compliant operations while achieving best-in-class turnaround times.
• Provide leadership, mentoring, training, and coaching to all Credentialing Specialists.
• Effectively work with internal department and clinical support to identify best practices and opportunities to improve quality performance.
• Meet with direct reports on a routine basis for one on ones, provide performance feedback, and coach/counsel employees as needed.
• Document performance when needed.
• Complete annual performance appraisals and recommend salary adjustments.
• Keep pace with regulatory changes and work internally to modify systems and processes to mitigate any negative impact.
• Manage and maintain positive engagement with CVO and other external credentialing vendors
• Maintain a comprehensive understanding of healthcare credentialing requirements.
• Support and Implement department goals and continuous process improvement initiatives.
• Provide support to the Credentialing Team to ensure adequate performance.

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