Credentialing Data Integrity Specialist
About The Position
In this temporary role the individual will be responsible for data clean up, maintenance and updates due to a system migration of the credentialling system. This individual will work closely with the Avera Health Plans credentialing leadership team as well as cross functional stakeholders from Avera Health to ensure accurate updates are made. Accountable for ensuring the credentialing requirements for governmental agencies and commercial managed care insurers/networks are met and managed appropriately so medical providers are enrolled in and maintain active credentialing status with such entities.
Requirements
- The individual must be able to work the hours specified.
- To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
- Associate's or an equivalent combination of education and experience
- 1-3 years medical experience and/or training; or an equivalent combination of education and experience
Responsibilities
- Responsible for the coordination of the credentialing process for the medical providers including obtaining all relevant documentation and application forms.
- Knowledge of all applicable state and government laws regarding credentialing and applies them to the credentialing process, which includes knowledge of PECOS Medicare organizational enrollment.
- Responds to applicants and current medical providers regarding the credentialing process and status.
- Responsible for accurate data entry and maintenance of the credentialing system.
- Assures files are complete and accurate for all clinics, providers, hospitals and also includes outreach hospitals.
- Assures that all re-credentialing paperwork is complete and accurate and ready for approval within the timeframes required by the payors.
- Assures that providers are notified between reappointment cycles by keeping accurate records of expiration dates.
- Maintaining NPI website and furnishing current W-9’s as requested.
Benefits
- PTO available day 1 for eligible hires.
- Up to 5% employer matching contribution for retirement
- Career development guided by hands-on training and mentorship
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
