Credentialing Data Integrity Specialist
Not Disclosed•TemporaryOn-site
location_on2867, East Sioux Street, Sioux Falls, Sioux Falls Township, Minnehaha County, South Dakota, 57103, United States
About Avera Health Plans
Avera Health Plans is part of a multidisciplinary team built with compassion, dedicated to the mission of "Moving Health Forward" for patients and the community. We strive to create a culture where every employee matters, promoting values of compassion, hospitality, and stewardship in everything we do.
About the Role
This temporary position plays a critical role during a system migration, focusing on data cleanup, maintenance, and updates for the credentialing system. You will work closely with the Avera Health Plans credentialing leadership team and cross-functional stakeholders to ensure accurate and timely updates are made.
In this role, you will be accountable for ensuring that credentialing requirements for governmental agencies and commercial managed care insurers are met. Your work ensures that medical providers are successfully enrolled and maintain active credentialing status with these entities. You will coordinate the credentialing process, manage documentation, and serve as a key point of contact for providers regarding their application status and reappointment cycles.
Hiring Process
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.
Work location
Work model: On-site
2867, East Sioux Street, Sioux Falls, Sioux Falls Township, Minnehaha County, South Dakota, 57103, United States
Sioux Falls, South Dakota
Key Responsibilities
- check_circleRespond to applicants and current medical providers regarding credentialing process and status
- check_circlePerform accurate data entry and maintenance of the credentialing system
- check_circleCoordinate the credentialing process for medical providers including obtaining documentation and application forms
- check_circleNotify providers between reappointment cycles by maintaining accurate expiration date records
- check_circleEnsure files are complete and accurate for all clinics, providers, hospitals, and outreach hospitals
- check_circleVerify re-credentialing paperwork is complete and ready for approval within required timeframes
- check_circleMaintain NPI website and furnish current W-9s as requested
- check_circleApply state and federal laws and accreditation standards to the credentialing process
Requirements
- verifiedAssociate's degree or equivalent combination of education and experience
- verified1-3 years medical experience and/or training
- verifiedKnowledge of state and federal laws regarding credentialing
- verifiedKnowledge of PECOS Medicare organizational enrollment
Benefits & Perks
check_circlePTO available day 1 for eligible hirescheck_circleUp to 5% employer matching contribution for retirementcheck_circleCareer development guided by hands-on training and mentorship
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Skills, education and keywords
Skills: Credentialing, Data Entry, Pecos Medicare, Npi, W-9.
Education: Associate's degree or equivalent combination of education and experience.
Frequently asked questions about Credentialing Data Integrity Specialist at Avera Health
What does a Credentialing Data Integrity Specialist at Avera Health do?expand_more
Day-to-day, the Credentialing Data Integrity Specialist at Avera Health will respond to applicants and current medical providers regarding credentialing process and status; perform accurate data entry and maintenance of the credentialing system; coordinate the credentialing process for medical providers including obtaining documentation and application forms; and notify providers between reappointment cycles by maintaining accurate expiration date records.
What are the requirements for this Credentialing Data Integrity Specialist role?expand_more
To qualify for the Credentialing Data Integrity Specialist at Avera Health position, applicants should have: Associate's degree or equivalent combination of education and experience; 1-3 years medical experience and/or training; Knowledge of state and federal laws regarding credentialing; and Knowledge of PECOS Medicare organizational enrollment.
Where is the Credentialing Data Integrity Specialist role at Avera Health located?expand_more
Credentialing Data Integrity Specialist at Avera Health is based in 2867, East Sioux Street, Sioux Falls, Sioux Falls Township, Minnehaha County, South Dakota, 57103, United States. This is a on-site role.
Is this Credentialing Data Integrity Specialist job remote, hybrid, or on-site?expand_more
Avera Health has listed this Credentialing Data Integrity Specialist role as on-site.
How much experience is required for this Credentialing Data Integrity Specialist role?expand_more
Credentialing Data Integrity Specialist at Avera Health typically requires 1–3 years of relevant experience at the entry level level.
What skills do you need for the Credentialing Data Integrity Specialist role at Avera Health?expand_more
Key skills for Credentialing Data Integrity Specialist at Avera Health include Credentialing; Data Entry; Pecos Medicare; Npi; and W-9.
What education is required for Credentialing Data Integrity Specialist at Avera Health?expand_more
Educational requirements for this role: Associate's degree or equivalent combination of education and experience.
What category does the Credentialing Data Integrity Specialist role belong to?expand_more
Credentialing Data Integrity Specialist at Avera Health is part of the healthcare & nursing job category on Recrutus.