Provider Enrollment Specialist

AEG Vision • Alton, IL

1d

About The Position

The primary purpose of this position is to assist the Credentialing Lead and Sr. Director, MVC/RCM perform the duties required to credential all doctors for all medical and vision plans.

Requirements

• High School or GED
• Experience in the managed care / medical insurance field
• Prior credentialing service experience, preferably in an medical or optometric environment
• Ability to understand insurance terminology & concepts to interpret plan requirements
• Effective verbal and written communication skills to speak with internal & external customers
• Basic PC skills to include MS Office, Windows, Word, and Excel
• Demonstrated ability to work successfully in a team environment, functioning for the good of the team over the individual

Responsibilities

• 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 My Doc and maintains credentialing files on each O.D. and M.D.
• Loads all new Doctors information into Credential My Doc, as well as maintains all Doctors files in Credential My Doc
• 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
• 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 Lead and Sr. Director, MVC/RCM
• Makes recommendations for efficiencies, processes, etc. which will deliver either quality, cost savings, and / or profitability improvements within the department

Benefits

• 401(k) with Match
• Medical/Dental/Life/STD/LTD
• Vision Service Plan
• Employee Vision Discount Program
• HSA/FSA
• PTO
• Paid Holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees