Credentialing Manager

Job not on LinkedIn

🔥 4 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 12%

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Midwest Eye Consultants

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

💰 Private equity on 2021-10

Healthcare • Healthcare Insurance • Retail

Midwest Eye Consultants is a multi-location eye care provider offering comprehensive ophthalmic and optometric services across Indiana and Ohio. They provide routine eye exams, diagnosis and treatment of eye diseases, dry eye testing and therapies, contact lenses, optical services including prescription sunglasses, blue light lenses, lens technology consultation, and LASIK-related care. The practice emphasizes personalized, community-connected care, employs a team of eye doctors and staff, supports charity programs, and maintains numerous clinic locations and eyewear retail offerings.

📋 Description

• Oversee all aspects of payer enrollment, recredentialing, and ongoing maintenance of provider participation in insurance networks • Manage the end-to-end credentialing lifecycle, including initial credentialing, recredentialing, and expiration tracking • Oversee payer enrollment applications, PECOS updates, CAQH maintenance, NPPES records, and delegated agreements • Monitor compliance with NCQA, CMS, and commercial payer standards • Maintain an accurate credentialing database • Lead, supervise, and support Provider Enrollment Specialists • Establish, document, and refine credentialing workflows, SOPs, and KPIs • Act as the primary liaison with insurance plans to resolve enrollment delays or issues • Monitor payer policy updates and state/federal regulations • Support credentialing-file audits • Provide weekly and monthly updates on credentialing status and turnaround times • Track and report pending expirations to avoid lapses • Prepare credentialing rosters and enrollment summaries • Champion company culture and commitment to patient care • Align strategic goals and resources to maximize profitability • Collaborate across the organization to develop scalable solutions • Participate in integration and post-acquisition teams as needed • Drive operational excellence and maintain compliance • Recruit, hire, train, motivate, retain, guide, and evaluate employees

🎯 Requirements

• Bachelor’s degree or equivalent experience required • 3-5 years of credentialing experience • 2+ years in a supervisory role • Experience in optometry/ophthalmology or outpatient healthcare preferred • Experience in delegated credentialing and/or managed care contracting preferred • CPCS or CPMSM certification preferred • Knowledge of NCQA, CMS, and commercial payer standards • Proficiency in Microsoft Office • Strong knowledge of CPT, ICD-10, and HCPCS codes relevant to optometry/ophthalmology • Knowledge of insurance guidelines relevant to optometry/ophthalmology • Strategic relationship management • Advanced communication skills • Influence and negotiation skills • Cross-functional collaboration • Process improvement and problem solving • Project and time management • Attention to detail and professional integrity • Ability to communicate effectively through verbal and written means • Ability to hear and understand spoken information in-person and via electronic means • Visual acuity to ensure accuracy of work on screens and documents • Ability to maintain focus and attention to detail for extended periods

🏖️ Benefits

• Remote position • Reasonable accommodations may be provided to qualified individuals with disabilities • Professional office and/or remote office setting • Equal Opportunity Employer