Sr. Specialist, Payer Enrollment

The primary purpose of this position is to on-board new doctors relative to CAQH, Credential My Doc, and general credentialing and contracting in order to ensure prompt payment from insurance plans.

• Procure payer contracts for the purpose of billing and payment collections
• Will be the Subject Matter Expert on documentation, workflow, and process for managed care & commercial/medical payors contracting processes
• Prepares and submits enrollment applications, contract requests, and CHOWS along with supporting documentation to payors to ensure timely enrollment
• Maintains and checks status of all pending and completed contract applications with payors
• Support the team in processing documentation required to initiate and maintain proper medical credentialing for doctors, both IOA & external providers, organizing and obtaining all needed documents from insurance plans and doctors, and submits to the insurance board for processing
• Tracks credentialing in process utilizing Credential Stream and maintains credentialing files on each O.D
• Load and maintain O.D. files in Credential Stream
• Maintains and updates all doctor’s CAQH applications
• Maintains credentialing spreadsheets and communicates changes in status to billing, retail, and call center staff
• Assists in on-boarding new doctors to initiate smooth credentialing process
• Assists the doctors in filing for/renewing OD and drug licenses
• Assists the MVC Director in re-contracting new AEG Practices so they are participating within an AEG Vision TIN
• Maintains excellent working relationships with payors and carrier contracting teams to ensure timely and accurate credentialing status
• Assist the Managed Care Director in activities related to contracting medical and vision plans
• Performs clerical / administrative duties in support of the Credentialing Manager and Managed Care Director
• Makes recommendations for efficiencies, processes, etc. which will deliver either quality, cost savings, and / or profitability improvements within the department
• May be asked to provide assistance with Managed Care/Operations related projects not listed in this description

Qualifications

• High school diploma or GED or equivalent
• Experience in the managed care/medical insurance field
• 3 years prior credentialing and contracting experience
• Ability to understand insurance terminology & concepts to interpret plan requirements
• Intermediate level PC skills in MS Windows, Word and Excel
• Effective verbal and written communication skills to effectively speak with coworkers and prepare concise and accurate reports
• Demonstrated ability to work successfully in a team environment, functioning for the good of the team over the individual