Lead Credentialing Operations Specialist

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The pay range for this position is listed below. Actual pay rate dependent upon experience.

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

• Oversees daily credentialing operations ensuring compliance quality and timely turnaround of credentialing activities.
• Monitors quality of work by conducting regular audits and tracking results.
• Resource for provider credentialing coordinators on department procedures using advanced knowledge of credentialing NCQA requirements State and Federal Credentialing laws and system configuration within the credentialing software system.
• Provides guidance resolves interdepartmental issues and serves as credentialing subject matter expert for internal and external departments.
• Monitor shared inboxes and respond within required timeframes.
• Support departmental projects and accreditation activities including NCQA audits.
• Develops and maintains standard operating procedures job aids and training materials for internal staff and providers completing credentialing.
• Review credentialing files and prepare Level 2 credentialing files for Credentialing Committee meetings.
• Prepares credentialing packets and works with physician Medical Directors for review. Ensures decision process is completed within set time-frames.
• Monitors monthly metrics and aging reports meeting with other departments to make to make necessary improvements when key performance indicators are not meeting goals.

• Bachelors Healthcare Administration Business Health Information or a related field or equivalent years of related experience.
• Certified Provider Credentialing Specialist (CPCS) - National Association of Medical Staff Services (NAMSS) or
• Certified Professional Medical Services Management (CPMSM) - National Association of Medical Staff Services (NAMSS)
• 4-6 years Experience in credentialing within a hospital insurance or managed care environment.
• In-depth knowledge of provider credentialing processes regulatory requirements and industry best practices.

• Strong analytical abilities with proficiency in data analysis and KPIs (Key Performance Indicators) development.
• Proven ability to enhance operational efficiency in fast-paced settings.
• Ability to drive continuous process improvements in a fast-paced environment.
• Experience with the following software: Outlook Microsoft Excel CACTUS/Provider Epic/Tapestry Health Trio and Maccess.

• Commitment to the daily application of Averas mission vision core values and social principles to serve patients their families and our community.
• Promote Averas values of compassion hospitality and stewardship.
• Uphold Averas standards of Communication Attitude Responsiveness and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles laws regulations and standards associated with but not limited to CMS The Joint Commission DHHS and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.

• Up to 5% employer matching contribution for retirement

• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability Veteran Status or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application please call 1- or send an email to .