Credentialing Specialist II Job at Avesis, Incorporated
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.
Do you want to be part of a collaborative Credentialing team? Are you a detail oriented individual who enjoys contributing to the quality of health care, who is excited by challenges and possesses good interpersonal skills to effectively interface between providers and business teams? Do you think big and grow, accelerate impact and lead change? Is a culture where “People Count,” “We Do the Right Thing,” and “We Hold Ourselves to Very High Standards” important to you? If so, Guardian is seeking a Credentialing Specialist II to participate in the credentialing of our provider network.
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.
As Credentialing Specialist II, you will develop and execute the key credentialing components for the Avesis provider network and ensure compliance with NCQA, regulatory and payer credentialing standards. You will be an key component to ensuring quality and will harness deep industry and technical expertise to develop and execute credentialing of Avesis providers ensuring a provider centric focus that supports enterprise growth.
You are
An experienced credentialing specialist who can perform accurate and timely credentialing and re-credentialing of provider applications in accordance with the departmental policies and procedures and in compliance with applicable State and Federal laws and regulations, as well as National Committee for Quality Assurance (NCQA) standards
You have
- High School Diploma or GED Required
- Associate degree or CPCS certified preferred
- 3 years credentialing experience, preferably in a managed care setting
- Working knowledge of NCQA standards and payer credentialing standards
- Strong computer, data entry and clerical skills
- Excellent interpersonal, oral, and written communication skills
- Critical thinking, detail oriented and strong organizational skills required
- Continuously strives to provide superior products and customer service
- Ability to adapt to and manage change
You will
- Receive and processes incoming applications and supporting credentials from providers
- Perform timely follow-up with providers on all pending applications
- Perform the primary source verification according to departmental policies and NCQA standards when not completed by CVO
- Builds and accurately maintain provider information in various systems
- Performs Quality Assurance of provider credentialing information in preparation for committee(s)
- Responds to inquiries from providers
- Provides support to Credentialing Specialist I on functional responsibilities
Reporting Relationships
As our Credentialing Specialist II, you will report to our Credentialing Supervisor, who reports to our Credentialing Manager.
Location
Remote – Work from home
Travel
< 5% of travel required for this role.
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
We Offer
- Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
- Competitive compensation package.
- 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.
Equal Employment Opportunity
At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You!
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