Description

Position Summary

Regional Credentialing Manager is responsible for maintaining active status and managing the contract administration for all providers within the Comprehensive Eyecare Partners market by successfully completing initial and subsequent credentialing packages as required by practices and surgery centers, commercial payers, Medicare and Medicaid and maintaining organizational records to communicate status back to providers and practice administrative team members. A market will include multiple practices and surgery centers.

JobType: Remote US

Roles and Responsibilities

• Compiles and maintains current and accurate data for all providers.
• Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
• Maintains copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers.
• Maintains knowledge of current health plans and agency requirements for credentialing providers.
• Maintains accurate Medicare and Medicaid enrollments and performs revalidations in a timely manner.
• Responsible to address and resolve payor issues (i.e.- billing, credentialing, contracts)
• Ensures timely response to provider data management requests from insurance companies.
• Tracks license and certification expirations for all providers to ensure timely renewals.
• Ensures practice addresses are current with health plans, agencies, and other entities.
• Processes applications for appointment and reappointment of privileges to ASC.
• Audits health plan directories for current and accurate provider information.
• Other duties as needed

Experience Requirements

• 2 years of relevant credentialing experience
• Advanced knowledge of Internet software, Microsoft Word Processor software and Microsoft Excel Spreadsheets.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent attention to detail.
• Excellent verbal and written communication skills.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.

Education Requirements

• High school or equivalent (Bachelor’s Degree Preferred)
• Certified Provider Credentialing Specialist (CPCS) preferred.

Physical Demands

• While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel. The employee is frequently required to stand, walk, and sit. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 50 pounds.  Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Benefits

• Comprehensive EyeCare Partners offers a competitive salary commensurate with experience, qualifications, and location.
  • Salary Range: $55,000 - $68,000
• 15 Paid Days off in your first year
• Medical, dental and vision benefits
• Scrub/ Shoe allowance for applicable roles
• Paid Holidays
• Company paid life insurance
• 401(K)
• Paid mileage between practices during work hours
• ORCA Pass and Free Parking where applicable
• On-going education available including certification reimbursement
• Discount Programs Including Vision discounts on products and services

Qualifications

Salary : $55,000 - $68,000