Credentialing Manager

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.

As the Manager of Credentialing, you will lead and innovate within our Credentialing Department where you can drive operational excellence and compliance. As a key player in our organization, you will provide strategic direction and oversight to the Credentialing Team across all lines of business. In this role, you will develop and implement policies, procedures, and best practices that ensure efficient and compliant operations.

This is your chance to make a meaningful impact on the healthcare industry while working in a flexible, forward-thinking environment. This is a vital role in supporting the integrity of our operations and ensuring that we provide the highest quality service to our members, providers, and stakeholders. In this critical role, your contributions will directly impact the quality of care that our members receive. By ensuring our providers meet stringent regulatory standards, you’ll help safeguard the organization against risk while supporting the ongoing success of our healthcare programs. Your work will have a tangible, positive impact on patient outcomes and provider relationships, and you'll play a key part in maintaining our company's reputation as a trusted healthcare partner.

As the Manager of Credentialing, you’ll work to uphold rigorous standards, ensuring adherence to State and Federal regulations, National Committee for Quality Assurance (NCQA) standards, and other industry benchmarks.  You will have direct responsibility for leading a team to administer all credentialing processes and services.  You’ll also have the opportunity to shape the future of provider data standards, process improvements, and team development, all while maintaining a culture of quality and compliance.  As the Manager, you will be the go-to expert on credentialing processes, guiding your team in maintaining best-in-class practices to support Avesis’ continued growth and success. If you have a passion for healthcare compliance, a proven track record of leadership, and a strategic mindset, we want you to join our fully remote, dynamic team at Avesis.

Competencies

Functional:

• Lead a first-class, metrics-driven credentialing operation maintaining compliant operations while achieving best-in-class turnaround times.
• Provide leadership, mentoring, training, and coaching to all Credentialing team members.
• Serve as a point of contact for internal and external clients as it relates to credentialing requirements, and credentialing needs.
• Maintain a comprehensive understanding of healthcare credentialing requirements.
• Implements department goals and continuous process improvement initiatives.
• Coordinate audits of Credentialing documents/processes.
• Implements performance management strategies as needed to optimize team member contributions.
• Facilitate Credentialing Committee and governance.
• Actively participate in the maintenance of the provider database(s) by receiving and communicating changes to appropriate parties and performing the changes within the system when necessary. Routinely monitors database(s) to assure accuracy (report changes to the appropriate data entry sources).
• Lead our delegated credentialing program, including program development, monitoring, and audits.
• Establish collaborative working relationships that support cross-functional relationships and accomplishments.

Core:

• Working knowledge of NCQA standards and payer credentialing standards required.
• Working knowledge of best practices for provider data management and maintenance.
• Knowledge of PSV (primary source verifications), CAQH, OIG (Office of Inspector General) & NPDB (National Practitioner Data Bank).
• Strong computer, data entry and analysis skills required.

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:

• Bachelor’s Degree in Business, Health Care related field or industry experience.
• 5+ years of experience in supervisory or management level experience in credentialing.
• Intermediate level use of Microsoft Excel.
• 3+ years of experience working with credentialing software.
• 5+ years of experience managing and maintaining provider network databases.
• 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 25 Mbps upload while hardwired and not on a VPN are sufficient.

Preferred Qualifications:

• CPCS Certification Preferred.
• Knowledge of vision, dental or hearing industry preferred.

FLSA Status:  Salary/Exempt
National Salary Range: $74,260 - $116,200

 

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 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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