Credentialing Specialist

Establish relationships with providers to obtain required regulatory information and manage all aspects of the providers' initial and ongoing credentialing requirements

Use independent judgment to ensure that documentation complies with appropriate state regulations

Oversee and manage assigned files in the CVO partner's system

Track in-progress credentialing files, identify and collect missing documents to ensure timely completion of the credentialing process for new and existing providers, and ensure that state regulatory standards are met

Research, analyze, and resolve complex credentialing issues and escalations, coordinating with internal and external business partners when needed, in order to meet compliance requirements

Use analytical and investigative skills to collect, evaluate, and compile information from regulatory reporting agencies, legal documents, and the provider to support the explanation of provider sanctions and/or malpractice claims

Compile required information for the Credentialing Committee in a clear and complete format that allows the Committee to render its decision on the provider's application

Exercise critical thinking and analytical skills in the initial entry and maintenance of provider data, ensuring the integrity of all shared provider information

Escalate issues to the appropriate business areas and drive solutions when applicable

Gather and assess necessary provider information for the legal department to support the Dispute Resolution Process for providers denied at the Committee or terminated from the network

Compose professional and concise correspondence to providers, retail chains, and office staff

Demonstrate a broad knowledge of the organization's strategic direction to achieve growth objectives and operational goals

Act as an internal resource for business partners

Job Specifications

Typically has the following skills or abilities:

Bachelor's Degree in a related field; in lieu of degree, 4 years of functional experience

Demonstrated professionalism and leadership in dealing with situations involving controversy and conflict, experience in 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 in the performance of job duties

Demonstrated ability to identify problems and provide creative solutions

Strong attention to detail, multi-tasking, organizational skills, and customer service skills

Proven ability to balance provider needs with corporate objectives

Ability to work independently and in a team environment

#LI-VENTURES

Compensation range for the role is listed below. Applicable salary ranges may differ across markets. Actual pay will be determined based on experience and other job-related factors permitted by law. As a part of the compensation package, this role may include eligible bonuses and commissions. For more information regarding VSP Vision benefits, please click here.

Unincorporated LA County Residents: Qualified Applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act, and any other similar laws.

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