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Hybrid Sr. Specialist, Payer Enrollment chez AEG Vision

AEG Vision · Alton, États-Unis d'Amérique · Hybrid

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The primary purpose of this position is to on-board new doctors relative to CAQH, Credential My Doc, and general credentialing and contracting in order to ensure prompt payment from insurance plans.


  • Procure payer contracts for the purpose of billing and payment collections
  • Will be the Subject Matter Expert on documentation, workflow, and process for managed care & commercial/medical payors contracting processes
  • Prepares and submits enrollment applications, contract requests, and CHOWS along with supporting documentation to payors to ensure timely enrollment
  • Maintains and checks status of all pending and completed contract applications with payors
  • Support the team in processing documentation required to initiate and maintain proper medical credentialing for doctors, both IOA & external providers, organizing and obtaining all needed documents from insurance plans and doctors, and submits to the insurance board for processing
  • Tracks credentialing in process utilizing Credential Stream and maintains credentialing files on each O.D
  • Load and maintain O.D. files in Credential Stream
  • Maintains and updates all doctor’s CAQH applications
  • Maintains credentialing spreadsheets and communicates changes in status to billing, retail, and call center staff
  • Assists in on-boarding new doctors to initiate smooth credentialing process
  • Assists the doctors in filing for/renewing OD and drug licenses
  • Assists the MVC Director in re-contracting new AEG Practices so they are participating within an AEG Vision TIN
  • Maintains excellent working relationships with payors and carrier contracting teams to ensure timely and accurate credentialing status
  • Assist the Managed Care Director in activities related to contracting medical and vision plans
  • Performs clerical / administrative duties in support of the Credentialing Manager and Managed Care Director
  • Makes recommendations for efficiencies, processes, etc. which will deliver either quality, cost savings, and / or profitability improvements within the department
  • May be asked to provide assistance with Managed Care/Operations related projects not listed in this description
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