The primary purpose of this position is to assist the Credentialing Manager and Managed Care Director perform the duties required to credential all doctors for all medical and vision plans.
Duties & 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 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