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