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New

Credentialing Specialist

AvMed

This is a Full-time position in Gainesville, FL posted November 24, 2022.

Embrace better opportunities.
Are you passionate about health, happiness and helping others? So are we. We’re committed to helping our health plan Members live a happy and healthy lifestyle, and we believe that it starts here first, with our Associates.
At AvMed, we provide the tools and opportunities to enhance, expand, and support each Associate’s personal and professional growth. From tuition reimbursement to exercise classes in the office, embrace a better career with AvMed and join our team!
Position: Credentialing Specialist
Scope of position: The Credentialing Specialist performs primary source verification by ensuring participating practitioners and/or providers possess the appropriate practice experience (practitioners only), licenses, certifications, privileges, professional liability coverage, education, and professional and other qualifications to provide a level of quality care consistent with professionally recognized standards. The specialist ensures all credentialing data and functions are maintained & documented properly within the credentialing database, including, but not limited to, primary verification of medical license, DEA, Board certification, malpractice liability claims history, disciplinary actions, etc.
Essential Job Functions:
Performs primary source verification of practitioner or provider credentials, including written requests and follow-up, in accordance with NCQA accrediting standards
Review new practitioner or provider files to assess completeness, and request-missing documents from practitioners.
Prepares practitioner or provider files per NCQA requirements for presentation to the Credentialing Committee; interacts with Provider Data Management Network and Provider Service Associates to ensure the timely completion of all credentialing functions. Refers issues appropriately and accurately to the next level of service when necessary
Effectively communicates with potential new providers, current providers and office staff; answer questions and provide credentialing related education relating to incoming inquiries from providers and internal departments regarding the credentialing process.
Maintain up-to-date knowledge of NCQA standards, and any other regulatory requirements, and knowledge of AvMed’s credentialing policies and procedures.
Performs additional duties and responsibilities as assigned by management
We Offer:
Competitive Salaries
Comprehensive Benefits: Medical Plans, Health Savings Account, Dental, Vision, and more…
Paid Time Off, Company Paid Holidays, Paid Time Off Cash-In
401(k)plan with matching contributions, Tuition Assistance, Associate Discounts
You have:
High school required
Associates Health or Business related preferred
0-2 years of previous experience in a physician group office practice, managed care organization credentialing environment, or hospital credentialing required
Some knowledge of managed care provider contracting methodologies preferred
You May Also Have:
Previous experience in a physician group office practice, managed care organization credentialing environment, or hospital credentialing
Strong problem-solving skills and ability to assist in resolution of issues as they arise analytic and interpretive ability
Basic knowledge of medical terminology
Ability to perform internet-based research required
Working knowledge of Microsoft Office 365 required
Some knowledge of managed care contracting methodologies preferred
Ability to manage multiple projects and assignments simultaneously
Basic typing skills required
Excellent organizational skills with strong orientation to detail
Environment:
At AvMed, you will find a family. Our Associates love all the opportunities for advancement, the flexible work environment and team activities. We also encourage our Associates to embrace a life rich in what matters most – health and happiness. We call it being WELLfluent. Join AvMed. Join the WELLfluent!
Location: Miami or Gainesville, Florida
This position is Hybrid 2 days in office and 3 days remote
AvMed is a tobacco/drug free workplace, EOE
PDN-97a8f052-f39b-4d8a-b9de-84f82db39709
Associated topics: family, family medicine, family practice physician, general practice, outpatient, physician, physician md, practitioner, primary care, urgent care