Credentialing Data Integrity Specialist

Location:

Avera Health Plans

Worker Type:

Temporary

Work 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 - $29.50

Position 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 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.

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:

• 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

Expectations and Standards

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s 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 1-605-504-4444 or send an email to talent@avera.org.