Sr. Specialist, Payer Enrollment

AEG Vision•Alton, IL

19d

About The Position

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.

Requirements

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

Responsibilities

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