Position:Full-Time
- Reviews, screens, and completes initial credentialing and/or recredentialing, and additional privilege request applications for completeness, accuracy, and compliance with federal, state, local, and Vision Web regulations, standards, policies, and guidelines.
- Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files. • Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes.
- Ensure all tasks duties comply with all regulatory and accreditation standards including The Joint Commission, the National Committee Quality Assurance (NCQA) guidelines, and Vision Web Standard Operating Procedures and Vision Web Policies and Procedures, to include Medicare and Medicaid for all states.
- Communicates clearly with providers, their credentialing representative, and leadership as needed to provide timely updates and responses on day-to-day credentialing and privileged issues as they arise.
- Analyzes, identifies, resolves discrepancies, time gaps, and other issues that could impact ability to credential healthcare practitioners.
- Report issues in a timely manner to Credentialing Manager for decision making in accordance with credentialing and privilege policy and federal state, local, and government and health plans standards.
- Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
- Responsible for monitoring and managing credentials/recredentialing requirements to ensure the collection of all required renewals are on file within their required time frame.
- Responsible for the timely entry, processing, and tracking of credential files.
- Uphold and ensure compliance, confidentiality and adhere to all HIPAA guidelines, and maintain a strict level of confidentiality for all company policies and procedures, departmental, and healthcare provider information as well as the overall mission and values of the organization.
- Assist with annual Health Plan delegated credentialing audits.
- Perform other job-related duties as assigned.
- Required: High School Diploma with a minimum of 3 years’, a working knowledge of federal and state regulatory agencies and accrediting bodies (CMS, TJC, NCQA, etc.)
Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process. To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at 1-888-887-3348 (be sure to provide your name and contact information so that we may follow up in a timely manner) or email HRCompliance@luxotticaretail.com.
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law. Native Americans in the US receive preference in accordance with Tribal Law.