Avera Health Plans
CredentialingDataIntegritySpecialist
“Credentialing Data Integrity Specialist at Avera Health Plans. Skills: data clean up, data maintenance, data updates, credentialing process, cross functional stakeholders. data clean up. maintenance and updates due to a system migration of the credentialing system”
What You'll Achieve.
ensure accurate updates are made; medical providers are enrolled in and maintain active credentialing status with such entities; ready for approval within the timeframes required by the payors
Industry & Context.
Primarily days with possible weekends/evenings/holidays, Maintain confidentiality, Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable
What They're Looking For.
Must Have
Associate's or an equivalent combination of education and experience, 1-3 years medical experience and/or or an equivalent combination of education and experience, visual acuity adequate to perform position duties, ability to communicate effectively with others, hear, understand and distinguish speech and other sounds
What You'll Do.
maintenance and updates due to a system migration of the credentialing system
coordination of the credentialing process for the medical providers
accurate data entry and maintenance of the credentialing system
Assures files are complete and accurate for all clinics
hospitals and also includes outreach hospitals
Assures that all re-credentialing paperwork is complete and accurate and ready for approval within the timeframes required by the payors
Assures that providers are notified between reappointment cycles by keeping accurate records of expiration dates
Maintaining NPI website and furnishing current W-9’s as requested
How You'll Work.
Team & Collaboration
work closely with the Avera Health Plans credentialing leadership team; cross functional stakeholders from Avera Health; Work effectively in a team environment, coordinating work flow with other team members
Communication Scope
communicate effectively with others; hear, understand and distinguish speech and other sounds; Responds to applicants and current medical providers regarding the credentialing process and status
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