Credentialing Specialist

Job description

Requisition ID:  834716 
Position: Full-Time

 

We are EssilorLuxottica, a global leader in the design, manufacture and distribution of ophthalmic lenses, frames and sunglasses. The Company brings together the complementary expertise of two industry pioneers, one in advanced lens technologies and the other in the craftsmanship of iconic eyewear, to create a vertically integrated business that is uniquely positioned to address the world’s evolving vision needs and the global demand of a growing eyewear industry.
 

With over 180,000 dedicated employees in 150 countries driving our iconic brands, our people are creative, entrepreneurial and celebrated for their unique perspectives and individuality. Committed to vision, we enable people to “see more and be more” thanks to our innovative designs and lens technologies, exceptional quality and cutting-edge processing methods. Every day we impact the lives of millions by changing the way people see the world.

 

Our portfolio of more than 150 renowned brands span various categories, from frames, lenses and instruments to brick and mortar and digital distribution as well as mid-range to premium segments. Our Shared Services Team, accompany and enable others within the EssilorLuxottica collective to achieve their targets. They keep people and projects running smoothly, ensuring every part of our business is provided for and well taken care of.

GENERAL FUNCTION

Under the direction of the Credentialing Supervisor, the Credentialing Specialist is responsible for coordinating all aspects of the credentialing and/or recredentialing process as well as changes in privileges/specialty or demographic information for health care professionals practicing within Vision Web. This position ensures health care professionals are appropriately credentialed and privileged, including ongoing maintenance and verification of current information on file and within the credentialing database, and other duties required to maintain compliance with regulatory and accreditation requirements.

 

MAJOR DUTIES AND RESPONSIBILITIES

·  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.

 

BASIC QUALIFICATIONS

·  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.)

 

PREFERRED QUALIFICATIONS

Preferred – Certified Professional Credentialing Specialist (CPCS) within the first 3 years of employment if not already certified upon hire.

Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package. Benefits may include health care, retirement savings, paid time off/vacation, and various employee discounts. 
 
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.

.jobTitle{ display:none !important; }

Nearest Major Market: Austin
Job Segment: Medicaid, Medicare, Ophthalmic, Healthcare

Apply now »