Credentialing Data Integrity Specialist
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Job Location:
Sioux Falls, SD - USA
Monthly Salary:
$ 22 - 29
Posted on:
5 hours ago
Vacancies:
1 Vacancy
Job Summary
Location:
Worker Type:
TemporaryWork Shift:
Primarily days with possible weekends/evenings/holidays (United States of America)Pay Range:
The pay range for this position is listed below. Actual pay rate dependent upon experience.
$22.00 - $29.50Position Highlights
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.
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.
A Brief Overview
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.
What you will do
- 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 federal laws and accrediation standards 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-9s as requested.
Essential Qualifications
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. These requirements and those listed above are representative of the knowledge skills and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions as long as the accommodations do not cause undue hardship to the employer.
Required Education License/Certification or Work Experience:
- Associates or an equivalent combination of education and experience
- 1-3 years medical experience and/or training; or an equivalent combination of education and experience
Expectations and Standards
- 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 .
Required Experience:
IC
