Credentialing Analyst

Responsible for credentialing data and reporting, ensuring all business partners have access to high-quality and accurate information. Develop and cultivate productive relationships with providers, retail chains, strategic partners, and their staff. Research and analyze ways to operationalize credentialing compliance requirements and recommend enhancements to procedures for all business areas within VSP. Elevate providers’ understanding of National Committee for Quality Assurance (NCQA) and industry-standard credentialing requirements. Act as a Subject Matter Expert (SME) for the team.

Establish relationships and represent Provider Network Development (PND) as an expert on credentialing regulatory requirements for all states, including for delegated credentialing

Manage all aspects of a provider’s initial and ongoing credentialing requirements; provide leadership and guidance to team for complex situations. Research, analyze, and resolve complex credentialing escalations, including matters that involve complicated ownership scenarios, private equity arrangements, Medicare and Medicaid compliance, and high-profile relationships

Analyze practice structure and documents submitted by providers in support of their practice ownership and credentialing information, and provide mentorship to team members

Oversee and manage the team’s assigned files in CVO partner’s system. Track in-progress credentialing files, ensuring timely completion of the credentialing process for new and existing providers and compliance with state regulatory requirements

Develop and monitor credentialing, reporting, and monthly reconciliations

Provide oversight for work related to strategic partners and delegated credentialing. Act as a resource to other departments on Medicare, Medicaid, and NCQA credentialing guidelines. Coordinate with internal and external business partners, when needed, to maintain regulatory compliance

Ensure SharePoint site remains updated with credentialing resources and documentation

Use analytical and investigative skills to collect, evaluate, and compile information from regulatory reporting agencies, legal documents, and the provider to support explanation of provider sanctions and/or malpractice claims.  Compile required information for the Credentialing Committee

Gather and assess necessary provider information for VSP’s legal department to support the Dispute Resolution Process for providers denied at Committee or termed from the network. Compose professional and concise correspondence to providers, retail chains, and office staff

Represent Provider Network Development as credentialing SME. Act as an internal resource for business partners

Job Specifications

Typically has the following skills or abilities:

Bachelor’s Degree or equivalent experience

6 years’ experience working directly with providers and staff on credentialing policies and procedures

Maintain professionalism in dealing with situations involving controversy and conflict, experience handling and resolving escalated issues

Advanced communication, influencing, and problem-solving skills

Ability to identify problems and provide creative solutions

Strong attention to detail, critical thinking, multi-tasking, organizational, and customer service skills

Ability to balance provider needs with VSP’s corporate objectives

Ability to work independently and in a team environment

Preferred Skills

Excellent time management

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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. 

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.