Credentialing Specialist II

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.

- 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

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 fo