Managed Vision Care - Lead, Network Management

Summary:

Monitor the credentialing and re-credentialing status of retail stores and doctors to ensure providers obtain active status in a timely manner. Research unpaid claims related to credentialing issues. Maintain MVC website data for all locations. Enroll new locations and doctors for EDI claim submission. Manage Network Management related research projects as needed.

Pay Class and Pay

Pay Class: Full Time

Pay: $16.66 - $21.36 per hour

Essential Responsibilities:

1. Manage claim issues generated by credentialing challenges, partner with Network Management Associates and Third Party Billing to produce resolutions.
2. Partner with Contracting Entities and EDI Clearinghouse to research and resolve claim submission and payment issues.
3. Communicate claim and payment resolutions to Third Party Billing.
4. Continually track and monitor claims that are on hold due to credentialing issues and routinely present status updates and resolutions to Management.
5. Partner with IT, Third Party Billing and Clearinghouse Vendor to ensure that all EDI requirements are met.
6. Manage the execution of Medicare & Medicaid enrollments.
7. Complete enrollment forms for EDI Clearinghouse for providers.

1. Support Network Management Team as needed with special projects.
2. Support SIT (Stores in Transition) Team act as a Liaison for MVC

Education:

• High School Diploma, GED, or equivalent work experience

Experience & Background:

• Three (3) plus years of related experience

• Proficient Microsoft Excel, Word and Access skills
• Working knowledge of Insurance Industry

Language Skills:

• Well-developed verbal, listening and phone communication skills

• Ability to speak effectively with all levels of Associates within the organization
• Ability to write routine reports and correspondence.

Mathematical Skills:

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and

decimals

Reasoning Ability

• Ability to think logically in following procedures and instructions

• Excellent organizational and communication skills
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to exercise good judgment and make sound decisions independently; delegate/escalate issues appropriately

Essential Responsibilities related to Physical Demands/Work Environment:

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the associate is required to stand, use hands and fingers to handle, feel, pick or pinch, and talk or hear most of the time. The associate is occasionally required to stand, walk, and reach with hands and arms. The associate must frequently lift and/or move up to 20 pounds. The noise level in this location is moderate (use of computers, printers and machines).

Essential Responsibilities related to Behavioral Characteristics:

• Multi-task orientated
• Exhibit empathy and good phone resolution skills
• Strong customer service focus and commitment
• Well-developed interpersonal skills. Ability to get along with diverse personalities; tactful, mature and flexible
• Ability to work onsite and participate in interactive onsite meetings on a regular and predictable basis.
• Ability to initiate immediate interaction, coordination and collaboration with team members, clients, customers etc.