Credentialing & Provider Enrollment en undefined

About Company:

Our globally recognized healthcare team is comprised of some of the top minds in ocular medicine. Our senior management team has a combined 200 years of eye industry experience collaborating with some of the most recognized practices in the nation. While our providers have the expertise to diagnose and treat complex ocular, oculoplastic, and retinal conditions, we’re also uniquely qualified to provide care for our patients from childhood though adulthood. We build relationships with our patients that last a lifetime.

With nearly 1,400 employees, we support over 50 clinic locations, five state-licensed ambulatory surgery centers, and over 110 surgeons, doctors, and other medical professionals. Our brands include OCLI Vision, Island Eye Surgi-center, New Vision Cataract Center, AIO, and others.

At Spectrum Vision Partners we know that cultivating diversity and fostering an inclusive work environment is critical to our impact and success. We create an environment where no individual is advantaged or disadvantaged because of their background. We offer equal opportunity employment regardless of race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability status, age, marital status, or protected veteran status. With a commitment to maintaining a bias-free environment in which harassment is prohibited, we respect cultural diversity and comply with the laws of the places in which we operate. We expect our business partners, suppliers, clients, and all of our team members to uphold these commitments.

About the Role:

The Credentialing & Provider Enrollment specialist plays a critical role in ensuring that healthcare providers are properly credentialed and enrolled with various insurance payers and regulatory bodies. This position is responsible for managing the end-to-end credentialing process, verifying provider qualifications, and maintaining compliance with industry standards and organizational policies. The role requires close collaboration with providers, insurance companies, and internal departments to facilitate timely enrollment and re-credentialing activities. The ultimate goal is to ensure that providers are authorized to deliver services and receive reimbursement without interruption. This position supports the organization's operational efficiency and financial integrity by maintaining accurate and up-to-date provider records.

Minimum Qualifications:

• High school diploma or equivalent; Associate’s or Bachelor’s degree in healthcare administration or related field preferred.
• Minimum of 2 years experience in healthcare credentialing, provider enrollment, or a related administrative role.
• Strong knowledge of healthcare payer credentialing requirements and processes.
• Proficiency with credentialing software and Microsoft Office Suite.
• Excellent organizational skills and attention to detail.

Preferred Qualifications:

• Experience working within a Central Business Office (CBO) or large healthcare organization.
• Familiarity with state and federal healthcare regulations impacting provider enrollment.
• Strong interpersonal and communication skills to effectively liaise with diverse stakeholders.
• Ability to manage multiple credentialing projects simultaneously in a fast-paced environment.

Responsibilities:

• Manage the complete credentialing and enrollment process for healthcare providers, including initial applications, re-credentialing, and ongoing maintenance.
• Verify provider credentials, licenses, certifications, and work history to ensure compliance with payer and regulatory requirements.
• Communicate effectively with providers, insurance companies, and internal teams to resolve credentialing issues and expedite enrollment approvals.
• Maintain accurate and organized documentation of all credentialing and enrollment activities in compliance with organizational policies and regulatory standards.
• Monitor credentialing expiration dates and initiate timely renewals to prevent lapses in provider participation with payers.

Skills:

In this role, strong organizational and analytical skills are essential to accurately verify and maintain provider credentials and ensure compliance with complex payer requirements. Communication skills are used daily to coordinate with providers, insurance companies, and internal teams to resolve issues and facilitate smooth enrollment processes. Proficiency with credentialing software and data management tools enables efficient tracking and documentation of credentialing activities. Attention to detail is critical to prevent errors that could delay provider enrollment or reimbursement. Additionally, problem-solving skills help navigate challenges related to credentialing discrepancies or regulatory changes, ensuring continuous provider participation and operational compliance.