Credentialing Specialist

VSP Vision Care•Cynthian, OH

About The Position

Develop and cultivate productive relationships with providers, retail chains, strategic partners, and their staff. Elevate providers’ understanding of industry standard credentialing requirements, leveraging team knowledge and resources. Establish relationships with providers to obtain required regulatory information and manage all aspects of the providers’ initial and ongoing credentialing requirements Use independent judgment to ensure that documentation complies with appropriate state regulations Oversee and manage assigned files in the CVO partner’s system Track in-progress credentialing files, identify and collect missing documents to ensure timely completion of the credentialing process for new and existing providers, and ensure that state regulatory standards are met Research, analyze, and resolve complex credentialing issues and escalations, coordinating with internal and external business partners when needed, in order to meet compliance requirements Use analytical and investigative skills to collect, evaluate, and compile information from regulatory reporting agencies, legal documents, and the provider to support the explanation of provider sanctions and/or malpractice claims Compile required information for the Credentialing Committee in a clear and complete format that allows the Committee to render its decision on the provider’s application Exercise critical thinking and analytical skills in the initial entry and maintenance of provider data, ensuring the integrity of all shared provider information Escalate issues to the appropriate business areas and drive solutions when applicable Gather and assess necessary provider information for the legal department to support the Dispute Resolution Process for providers denied at the Committee or terminated from the network Compose professional and concise correspondence to providers, retail chains, and office staff Demonstrate a broad knowledge of the organization's strategic direction to achieve growth objectives and operational goals Act as an internal resource for business partners

Requirements

Bachelor's Degree in a related field; in lieu of degree, 4 years of functional experience
Demonstrated professionalism and leadership in dealing with situations involving controversy and conflict, experience in handling and resolving escalated issues
Demonstrated advanced communication, influencing, and problem-solving skills
Experience working directly with providers and staff on credentialing policies and procedures
Regularly exercise discretion and independent judgment in the performance of job duties
Demonstrated ability to identify problems and provide creative solutions
Strong attention to detail, multi-tasking, organizational skills, and customer service skills
Proven ability to balance provider needs with corporate objectives
Ability to work independently and in a team environment

Responsibilities

Develop and cultivate productive relationships with providers, retail chains, strategic partners, and their staff.
Elevate providers’ understanding of industry standard credentialing requirements, leveraging team knowledge and resources.
Establish relationships with providers to obtain required regulatory information and manage all aspects of the providers’ initial and ongoing credentialing requirements
Use independent judgment to ensure that documentation complies with appropriate state regulations
Oversee and manage assigned files in the CVO partner’s system
Track in-progress credentialing files, identify and collect missing documents to ensure timely completion of the credentialing process for new and existing providers, and ensure that state regulatory standards are met
Research, analyze, and resolve complex credentialing issues and escalations, coordinating with internal and external business partners when needed, in order to meet compliance requirements
Use analytical and investigative skills to collect, evaluate, and compile information from regulatory reporting agencies, legal documents, and the provider to support the explanation of provider sanctions and/or malpractice claims
Compile required information for the Credentialing Committee in a clear and complete format that allows the Committee to render its decision on the provider’s application
Exercise critical thinking and analytical skills in the initial entry and maintenance of provider data, ensuring the integrity of all shared provider information
Escalate issues to the appropriate business areas and drive solutions when applicable
Gather and assess necessary provider information for the legal department to support the Dispute Resolution Process for providers denied at the Committee or terminated from the network
Compose professional and concise correspondence to providers, retail chains, and office staff
Demonstrate a broad knowledge of the organization's strategic direction to achieve growth objectives and operational goals
Act as an internal resource for business partners