Credentialing Specialist II

Avesis; United States; Remote; USD 25,000 - 41,000; Full time

Benefits offered by this job

Health coverage

401(k) match

Tuition assistance

Parental leave

Flexible time off

Job summary

Avsis is hiring for a remote credentialing specialist responsible for ensuring provider data accuracy, compliance with NCQA standards, and timely onboarding. You will collaborate with cross-functional teams to verify documentation and support credentialing workflows.

The role emphasizes strong data entry, attention to detail, and member-focused service, with opportunities for growth and a competitive benefits package.

Qualifications

• Associate degree or equivalent combination of education and experience.
• 3 years credentialing experience, preferably in a managed care setting.
• Remote role requires reliable internet (50 Mbps/10 Mbps) when hardwired and not on VPN.

Responsibilities

• Facilitate provider onboarding, including data import from CVO and documentation alignment with standards.
• Perform timely follow-ups with providers on pending applications/information.
• Perform primary source verifications per departmental policies and NCQA standards.
• Build and maintain provider information across systems.
• Respond to inquiries on the status of provider applications.

Skills

Credentialing experience

Education

Associate degree

Job description

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.

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 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!

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:

Zone A: $16.68-$27.81Zone B: $18.14-$30.24Zone C: $19.55-$32.59FLSA Status: Hourly/Non-Exempt

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.

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!