Credentialing Specialist

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If you've worn a pair of glasses, we've already met.

We are a global leader in the design, manufacture, and distribution of ophthalmic lenses, frames, and sunglasses. We offer our industry stakeholders in over 150 countries access to a global platform of high-quality vision care products (such as the Essilor brand, with Varilux, Crizal, Eyezen, Stellest and Transitions), iconic brands that consumers love (such as Ray-Ban, Oakley, Persol, Oliver Peoples, Vogue Eyewear and Costa), as well as a network that offers consumers high-quality vision care and best-in-class shopping experiences (such as Sunglass Hut, LensCrafters, Salmoiraghi & Vigano and the GrandVision network), and leading e-commerce platforms.

Join our global community of over 190,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry.

Discover more by following us on LinkedIn!

Your #FutureInSight with EssilorLuxottica

Are you willing to pioneer new frontiers, foster inclusivity and collaboration, embrace agility, ignite passion, and make a positive impact on the world? Join us in redefining the boundaries of what's possible.

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.

Our Diversity, Equity and Inclusion commitment

We are committed to creating an inclusive environment for all employees. We celebrate diversity and provide equal opportunities to all, regardless of race, gender, ethnicity, religion, disability, sexual orientation, or any other characteristic that makes us unique