Assistant Manager, Credentialing

at  Avesis Incorporated

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The Credentialing Assistant Manager is responsible for overseeing the credentialing process for healthcare professionals within an organization. They work closely with the Credentialing Manager leading a team to administer all credentialing processes and services, this includes verifying education, employment history, and professional references, as well as conducting background checks and ensuring compliance with regulatory requirements. The Credentialing Assistant Manager also assists in managing the credentialing database, maintaining accurate records, and coordinating with internal departments and external agencies to facilitate the credentialing process. They are responsible for ensuring the credentialing and compliance processes for network providers is efficient, operationally sound, and proactively in line with applicable State and Federal laws and regulations, as well as National Committee for Quality Assurance (NCQA) standards.

Functional Competencies:

• Maintain a comprehensive understanding of healthcare credentialing requirements
• Assist in leading a top-tier, 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
• Facilitate completion of department goals and continuously monitor 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)
• Assist in Leading our delegated credentialing program, including program development, monitoring, and audits.
• Establish collaborative working relationships that support cross-functional relationships and accomplishments

Behavioral Competencies:

• 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 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’s degree in business or health care related field or equivalent military or industry experience
• 3-5 years of experience in supervisory or management level experience in credentialing
• Demonstratable knowledge of NCQA standards
• Demonstratable knowledge of payer credentialing standards
• Must have CPCS Certification or earn within 120 days of hire
• Excellent interpersonal, oral, and written communication skills required
• 3-5 years of experience with MS Office and be comfortable operating with multiple open screens and systems simultaneously
• 3-5 years of experience in vision, dental or medical related field
• Demonstratable critical thinking, organizational skills required
• Must be detail oriented and with high accuracy rate providing superior products and customer service
• Must be able to work independently
• Ability to form collaborative relationships that are mutually respectful
• Ability to prioritize and manage multiple tasks and responsibilities efficiently, while exercising strong delegation skills.
• 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:

• Good problem-solving abilities
• Ability to research problems and find workable solutions
• Ability to multi-task and work in a fast-paced environment
• Excellent time management skills

FLSA Status: Salary/Exempt
National Salary Range: $67,490 - $105,590
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

Please refer the Job description for details