<p>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.</p> <ul> <li>Procure payer contracts for the purpose of billing and payment collections </li><li>Will be the Subject Matter Expert on documentation, workflow, and process for managed care & commercial/medical payors contracting processes </li><li>Prepares and submits enrollment applications, contract requests, and CHOWS along with supporting documentation to payors to ensure timely enrollment </li><li>Maintains and checks status of all pending and completed contract applications with payors </li><li>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 </li><li>Tracks credentialing in process utilizing Credential Stream and maintains credentialing files on each O.D </li><li>Load and maintain O.D. files in Credential Stream </li><li>Maintains and updates all doctor's CAQH applications </li><li>Maintains credentialing spreadsheets and communicates changes in status to billing, retail, and call center staff </li><li>Assists in on-boarding new doctors to initiate smooth credentialing process </li><li>Assists the doctors in filing for/renewing OD and drug licenses </li><li>Assists the MVC Director in re-contracting new AEG Practices so they are participating within an AEG Vision TIN </li><li>Maintains excellent working relationships with payors and carrier contracting teams to ensure timely and accurate credentialing status </li><li>Assist the Managed Care Director in activities related to contracting medical and vision plans </li><li>Performs clerical / administrative duties in support of the Credentialing Manager and Managed Care Director </li><li>Makes recommendations for efficiencies, processes, etc. which will deliver either quality, cost savings, and / or profitability improvements within the department </li><li>May be asked to provide assistance with Managed Care/Operations related projects not listed in this description </li><li>High school diploma or GED or equivalent </li><li>Experience in the managed care/medical insurance field </li><li>3 years prior credentialing and contracting experience </li><li>Ability to understand insurance terminology & concepts to interpret plan requirements </li><li>Intermediate level PC skills in MS Windows, Word and Excel </li><li>Effective verbal and written communication skills to effectively speak with coworkers and prepare concise and accurate reports </li><li>Demonstrated ability to work successfully in a team environment, functioning for the good of the team over the individual </li></ul>