Job Description

 JOB DUTIES:

· Review initial and reappointment credentialing applications and conduct follow-up, as needed

· Perform primary source verification of all credentialing requirements: education, training, experience, certification and licensing

· Assist with preparation of credentialing packets, participate and assist in facilitating credentialing committee meetings

· Maintain provider state licenses, DEA certificates, malpractice insurance and any other expirable documents

· Communicate appointment, reappointment, clinical privileging decisions and changes to providers and internal/external parties, as required

· Access external databases to obtain required documents necessary to complete credentialing applications

· Populate, maintain and update credentialing database to ensure accountability for the integrity of the information entered in the system.

· Perform research of state licensing and credentialing requirements in California and other regions

· Prepare and submit enrollment applications for both government, commercial health/vision plans for all applicable networks

· Manage validation of provider rosters for accuracy, as required by contracted health/vision plans

· Review provider directory listing(s) and follow-up with health/vision plans to ensure submissions have been accurately processed

· Respond to requests/inquiries from health plans, as well as other departments

· Perform general administrative tasks, including support for all NVISION centers

· Assist with special projects, as needed

QUALIFICATIONS:

· Knowledge and understanding of credentialing process, federal and state regulatory requirements and accreditation standards

· Knowledge and understanding of provider enrollment process

· Experience with managing/maintaining provider directory information within a managed care setting

· Ability to work independently with minimal supervision

· Must have strong organizational and time management skills

· Ability to work on multiples projects and meet deadlines

· Excellent communication and relationship building skills

· Detail oriented

· Understanding of medical terminology

· Be a TEAM player

EDUCATION AND EXPERIENCE:

· High school diploma required; Associate or Bachelor’s degree preferred

· 3+ years’ experience with provider enrollment, credentialing and primary source verification

· Credentialing experience within a managed care setting preferred

· Experience with MD Staff credentialing software preferred

· Proficient in Microsoft Word and Excel

Company Description

NVISION® Eye Centers is a diverse community of physicians, clinical and professional team members and optometrist affiliates dedicated to restoring exceptional vision for every patient. We strive to delight our patients by providing unrivaled care and service that exceeds their expectations. We are The Eye Doctors’ #1 Choice®