Credentialing Specialist

Develop and cultivate productive relationships with providers, retail chains, strategic partners, and their staff. Elevate providers’ understanding of industry standard credentialing requirements, leveraging team knowledge and resources. 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 . Salary Ranges: $58,656.00 - $80,253.00 VSP Vision is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to age, gender, race, color, religion, sex, national origin, disability or protected veteran status . We maintain a drug-free workplace and perform pre-employment substance abuse testing. 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. Notice to Candidates: Fraud Alert - Fake Job Opportunity Solicitations Used to Collect Fees/Personal Information. We have been made aware that fake job opportunities are being offered by individuals posing as VSP Vision and affiliate recruiters. Click here to learn about our application process and what to watch for regarding false job opportunities. As a regular part of doing business, VSP Vision (“VSP”) collects many different types of personal information, including protected health information, about our audiences, including members, doctors, clients, brokers, business partners, and employees. VSP Vision employees will have access to this sensitive personal information and are subject to follow Information Security and Privacy Policies.