Credentialing Specialist II

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.

Scope:

In this role as Credentialing Specialist II, you'll play a crucial role in ensuring our network of healthcare providers meets the highest standards of quality and professionalism. You'll be responsible for processing provider applications for credentialing and re-credentialing, maintaining compliance with state, federal, and NCQA guidelines, and ensuring smooth, efficient operations within the team. If you thrive in a fast-paced environment and have a keen eye for detail, this is your chance to make a real impact while developing your career in a critical area of healthcare operations.

Job Summary:

You will 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.

Competencies:

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.
• 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.

Minimum Qualifications:

• 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.

Preferred Qualifications:

• CPCS certified

At Avsis, we strive to design equitable, and competitive compensation programs. Base pay within the range is ultimately determined by a candidate's skills, expertise, or experience. In the United States, we have three geographic pay zones. For this role, our current pay ranges for new hires in each zone are:

This role may also be eligible for benefits, bonuses, and commission.

Please visit Avesis Pay Zones for more information on which locations are included in each of our geographic pay zones. However, please confirm the zone for your specific location with your recruiter.

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.

How To Stay Safe

Avsis is aware of fraudulent activity by individuals falsely representing themselves as Avsis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.

Avsis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during our process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avsis recruiters will come from a verified email address ending in @ Avsiscom.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avsis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

Equal Employment Opportunity

At Avsis, 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 Avsis, 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 Avsis, where We See You!