Previous Job
Previous
Credentialing Coordinator
Ref No.: 19-06985
Location: Mason, Ohio
The Credentialing Analyst serves as one of the main resources to administer the credentialing and re-credentialing activities with the team. Ensures all EyeMed providers meet the credentialing requirements for participation. This person also drives process improvements with the credentialing process and makes recommendations to streamline/drive efficiencies.

MAJOR DUTIES AND RESPONSIBILITIES
  • Assesses and drives process improvement to credentialing and re-credentialing processes
  • Data-driven decision making for recommending process change
  • Demonstrates the ability to work through end to end process impacts
  • Supports the overall provider credentialing and re-credentialing processes while maintaining standard turn-around times
  • Responsible to ensure the credentialing files and re-credentialing files are started on time and continue in the process according to standards.
  • Monitors participating provider network for credentialing/re-credentialing deficiencies and takes necessary action per the policies and procedures
  • Terminates providers who do not comply with the credentialing standards
  • Prepares and executes outbound communications related to the credentialing events
  • Researches discrepancies related to provider information.
  • Supports the preparation of weekly rosters to present providers for committee approvals/denials
  • Supports credentialing audits by pulling files and preparing the files for presentation to external clients
  • Obtains missing information from various sources including the provider to ensure provider maintains compliance with EyeMed Network
  • Executes reports to review and make necessary updates to provider information and provide status to management
  • Prepare reports of status on credentialing activities
BASIC QUALIFICATIONS
  • Associate or bachelors degree
  • 2-3 years business experience with healthcare provider credentialing
  • Proficient in Microsoft Office Products (Word, Excel, Access)
  • Excellent communication skills (written/verbal)
  • Ability to work well independently, under pressure and multi-tasking
  • Ability to successfully work on multiple projects simultaneously while managing time effectively
PREFERRED QUALIFICATIONS
  • Knowledge of business process management
  • Demonstrates sense of urgency
  • Experience with operating systems such as EDW/Business Objects