Credentialing Specialist

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $25 - $27 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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iCareManager

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

iCareManager is a company that operates as an integrated specialty network and administrator of comprehensive ocular care services. As a part of VSP Vision, iCareManager focuses on promoting exceptional member and provider experiences and improving ocular health outcomes while reducing costs. The company provides a range of ocular health managed care solutions for healthcare plans, including Medicare, Medicaid, and other government programs. With a network of optometrists and ophthalmologists, iCareManager simplifies ocular care delivery through network management, MSO services, and utilization management, among others. The organization emphasizes improving diabetic vision outcomes, access to affordable eye care, and efficient claims processing.

📋 Description

• Develop and cultivate productive relationships with providers, retail chains, strategic partners, and their staff • Educate providers about industry-standard credentialing requirements using team knowledge and resources • Establish provider relationships to obtain regulatory information and manage initial and ongoing credentialing requirements • Ensure documentation complies with applicable state regulations • Oversee assigned files in the CVO partner’s system • Track credentialing files and collect missing documents to ensure timely completion and regulatory compliance • Research, analyze, and resolve complex credentialing issues and escalations • Coordinate with internal and external business partners to meet compliance requirements • Collect, evaluate, and compile information from regulatory reporting agencies, legal documents, and providers regarding sanctions and malpractice claims • Compile information for the Credentialing Committee to support provider application decisions • Enter and maintain provider data while ensuring information integrity • Escalate issues and drive solutions • Gather provider information for the legal department’s Dispute Resolution Process • Compose professional correspondence to providers, retail chains, and office staff • Support organizational growth objectives and operational goals • Act as an internal resource for business partners

🎯 Requirements

• Bachelor's degree in a related field; in lieu of degree, 4 years functional experience • Demonstrated professionalism and leadership in situations involving controversy and conflict • Experience handling and resolving escalated issues • Demonstrated advanced communication, influencing, and problem-solving skills • Experience working directly with providers and staff on credentialing policies and procedures • Regularly exercise discretion and independent judgment • Ability to identify problems and provide creative solutions • Strong attention to detail, multitasking, organizational, and customer service skills • Proven ability to balance provider needs with corporate objectives • Ability to work independently and in a team environment • For remote or hybrid roles, high engagement in virtual environments, including maintaining camera presence during meetings

🏖️ Benefits

• Remote work option (Work From Home) • Hybrid work option (partial onsite at a VSP location and Work From Home)