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.

Essential Job Functions:

• Receives and processes incoming applications and supporting credentials from providers
• Performs timely follow-up with providers on all pending applications
• Performs the primary source verification according to departmental policies and NCQA standards when not completed by CVO
• Builds and accurately maintains provider information in various systems
• Performs Quality Assurance of all provider credentialing information in preparation for committee(s)
• 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

Qualification Requirements:

• High School Diploma or GED Required
• Associate degree or CPCS certified preferred
• 3 years credentialing experience required, preferably in a managed care setting
• Working knowledge of NCQA standards and payer credentialing standards
• Knowledge of vision, dental or hearing industry preferred
• Beginner Excel skills: Data entry, formatting, basic formulas; such as sum and average, basic charts, cell referencing
• Working knowledgeof Symplr / Cactus software preferred
• 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

FLSA Status: Hourly / Non-Exempt

National Hourly Rate Range: $16.68 - $26.07

How to stay safe:

Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis 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.

Avesis 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 process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

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. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

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 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!