Avēsis
CredentialingSpecialistII
Neural analysis suggests this role is
optimal for Mid candidates.
“Credentialing Specialist II at Avēsis. Skills: provider onboarding, credentialing, data management, compliance. 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”
What You'll Achieve.
ensuring our healthcare partners meet regulatory requirements and industry best practices, directly impacting the quality of care delivered to patients.; ensure provider data is accurate, up-to-date, and compliant.; shape a trusted network of healthcare providers, ensuring patients receive care from credentialed and qualified professionals.
Industry & Context.
Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.
What They're Looking For.
Must Have
3 years credentialing experience, preferably in a managed care setting, Associate degree or equivalent combination of education and experience, 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 Have
CPCS certified
What You'll Do.
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 on functional responsibilities.
How You'll Work.
Team & Collaboration
work closely with cross-functional teams; ability to mentor and support team growth; 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.
Communication Scope
Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
Full Job Description
# **Join us for an exciting career with the leading provider of supplemental benefits!** O**ur 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. **Functional:** * 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. **Core:** * Working knowledge of NCQA standards and payer credentialing standards. * Knowledge of vision, dental or hearing industry. * Strong computer, data entry and clerical skills. **Behavioral:** * 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.
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