Managed Vision Care - Lead, Network Management
San Antonio, TX, United States
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:
Manage claim issues generated by credentialing challenges, partner with Network Management Associates and Third Party Billing to produce resolutions.
Partner with Contracting Entities and EDI Clearinghouse to research and resolve claim submission and payment issues.
Communicate claim and payment resolutions to Third Party Billing.
Continually track and monitor claims that are on hold due to credentialing issues and routinely present status updates and resolutions to Management.
Partner with IT, Third Party Billing and Clearinghouse Vendor to ensure that all EDI requirements are met.
Manage the execution of Medicare & Medicaid enrollments.
Complete enrollment forms for EDI Clearinghouse for providers.
Support Network Management Team as needed with special projects.
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).
Activity
Amount of Time
None
Under 1/3
1/3 to 2/3
Over 2/3
Stand
x
Walk
x
Sit
x
Use hands to finger, handle, or feel
x
Reach with Hands and Arms
x
Climb or balance
x
Stoop, kneel, crouch, or crawl
x
Talk or hear
x
Close Vision (clear vision at 20" or less)
x
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.
HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company's Privacy & Security Training Program.
Visionworks is an equal opportunity employer, committed to the hiring, advancement and fair treatment of individuals without regard to race, color, religion, sex, age, sexual orientation, gender, national origin, ethnicity, disability or veteran status, or any other protected status designated by federal, state or local law.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to perform the job successfully. As required by changing business needs, complete additional essential responsibilities as identified and assigned.
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