Credentialing Operations Specialist: Impact & Compliance

Avera Health Plans Inc; Sioux Falls (SD); On-site; USD 30,000 - 41,000; Full time

Benefits offered by this job

PTO from day 1

Career development mentorship

Job summary

Avera Health Plans is seeking a Credentialing Operations Specialist to coordinate provider credentialing and enrollment activities in compliance with NCQA and state/federal requirements. You will review applications, resolve issues with providers and internal teams, and support audits.

Responsibilities include maintaining credentialing data, assisting in committee file preparation, and ensuring timely, compliant communications regarding provider status.

Qualifications

• Associate's degree required; 1-3 years credentialing experience preferred.
• Knowledge of NCQA credentialing standards and state/federal laws.
• Experience with provider enrollment and contracting processes.
• Strong attention to detail and effective communication skills.

Responsibilities

• Coordinate initial enrollment and re-enrollment for providers and facilities.
• Review credentialing applications for NCQA compliance and completeness.
• Prepare files for Medical Director and credentialing committee review.
• Maintain credentialing data and respond to applicants and providers.

Skills

Credentialing experience

Provider enrollment

Communication

Attention to detail

Education

Associate's degree

Bachelor's degree

Tools

Credentialing software

Enrollment systems

Job description

Avera Health Plans is seeking a Credentialing Operations Specialist to coordinate provider credentialing and enrollment activities in compliance with NCQA and state/federal requirements. You will review applications, resolve issues with providers and internal teams, and support audits.

Responsibilities include maintaining credentialing data, assisting in committee file preparation, and ensuring timely, compliant communications regarding provider status.