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Managed Care Credentialing Coordinator
2 months ago
At National Vision we believe everyone deserves to see their best to live their best. We help people by making quality eye care and eyewear more affordable and accessible. National Vision is one of the largest optical retail companies in the United States with over 1,100 stores. We operate four retail brands: America’s Best Contacts & Eyeglasses, Eyeglass World, and Vista Opticals inside select Fred Meyer stores and on select military bases. We offer an innovative culture where training is a priority, hard work is praised, and career growth is a reality. We are currently searching for a Credentialing Coordinator to join our Managed Care team This role ensures National Vision's (NVI) doctors are credentialed per the industry's credentialing standards. What Would You Do? The Specifics. Communicates to Optometrists the credentialing instructions and directs them to the on-line Credentialing Verification Organization and supplies the Doctors all the necessary information and documentation needed to complete the on-line credentialing process. Provides support to Optometrists as well as the Credentialing Verification Organization to ensure that credentialing is completed in a timely manner. May offer to perform such duties on behalf of any provider that gives such access to credentialing agent. Reviews Optometrists applications and composes credentialing instructions based on the data provided and data necessary to meet the National Committee for Quality Assurance (NCQA) credentialing guidelines and requirements. Rosters and adds new Optometrists into the Council for Affordable Quality Healthcare ProView (CAQH) system as well as (OHP) One Health Port for Washington providers. These systems are for doctors to self-report professional and practice information to payers, large provider groups and health systems. Works with Managed Care plans during annual file audits, pulling requested files for our delegated plans and providing any feedback needed.to maintain those relationships and successfully pass audits. Ensures functions are completed timely and accurately to fully credential doctors within expected service level agreements and to maintain compliance with all regulatory and governing entities Updates, maintains, and checks for accuracy of the credentialing information in VCM database, an internal database that tracks NVI Doctor's information that relates to the credentialing process. Responds to requests from management/staff/providers/doctors or outside entities related to credentialing. Constantly monitors for sanctions against licenses, negative NPDB reports, documents with upcoming expiration dates (medical licenses, insurance, attestations etc.), upcoming re-credentialing dates, doctor transfers, patient complaints, and doctor terminations. Takes the appropriate action to protect patients and doctors privacy while ensuring that National Vision's credentialing requirements are met at all times. Maintains on-line file management system for doctors housed within the VCM platform. Works closely with the Managed Care Sales team to ensure timely enrolments of all NVI providers with Managed Care Plans. Maintains expirables off all nature to ensure provider's credentials are up to date. Processes terminations, updates internal and external databases and ensures all parties are notified when doctors leave our network. Maintains continued and up to date knowledge of each state's specific credentialing requirements. Work Experience 0-2 years related experience and/or training or equivalent combination of education and experience (Required) Education Four year college degree or equivalent experience. resulting in broad knowledge of a field related to the job, such as accounting, marketing, business administration, agriculture etc. (Preferred) Additional Skills Credentialing experience and/or working closely with doctors is preferred. Knowledge of NCQA credentialing requirements and/or Managed Care experience is a plus. Taking Care of our People We understand the importance of financial health and security, and because of that, we provide competitive compensation to all Associates. We also offer a comprehensive benefits package including health and dental insurance, 401k retirement savings with company match, flex spending account, paid personal time off, paid company holidays, parental leave, employee eyewear discount and much, much more. At National Vision, we strive to deliver opportunities for professional growth and long-term career fulfillment. We provide training programs, access to educational courses and pride ourselves on the ever-increasing amount of promotions from within. We value and respect the unique and individual differences that everyone brings. We embrace all differences in matters of diversity, equity, and inclusion to create a place where people want to come, stay, and do their best work. We are an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, veteran status, and other legally protected characteristics.
