Provider Enrollment Specialist

The primary purpose of this position is to assist the Credentialing Lead and Sr. Director, MVC/RCM perform the duties required to credential all doctors for all medical and vision plans.

• 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 submit to the insurance board for processing
• Track credentialing in process utilizing Credential My Doc and maintain credentialing files on each O.D. and M.D.
• Load all new Doctors information into Credential My Doc, as well as maintain all Doctors files in Credential My Doc
• Maintain and update all doctor’s CAQH applications
• Maintain credentialing spreadsheets and communicate changes in status to billing, retail, and call center staff
• Assist in onboarding new doctors to initiate smooth credentialing process
• Assist the doctors in filing for/renewing OD and drug licenses
• Maintain 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
• Perform clerical / administrative duties in support of the Credentialing Lead and Sr. Director, MVC/RCM
• Make recommendations for efficiencies, processes, etc. which will deliver either quality, cost savings, and / or profitability improvements within the department

• High School or GED
• Experience in the managed care / medical insurance field
• Prior credentialing service experience, preferably in an medical or optometric environment
• Ability to understand insurance terminology & concepts to interpret plan requirements
• Effective verbal and written communication skills to speak with internal & external customers
• Basic PC skills to include MS Office, Windows, Word, and Excel
• Demonstrated ability to work successfully in a team environment, functioning for the good of the team over the individual

• 401(k) with Match
• Medical/Dental/Life/STD/LTD
• Vision Service Plan
• Employee Vision Discount Program
• HSA/FSA
• PTO
• Paid Holidays

* Benefits applicable to full Time Employees only.

• This position requires the ability to communicate and exchange information, utilize equipment necessary to perform the job, and move about the office.