Provider Credentialing Specialist (Healthcare)

Job Description

Job Description

Schedule: Standard full-time schedule, Monday through Friday. Hybrid – 3 days onsite and 2 days remote/work from home each week.

Spectrum Vision Partners (SVP) and OCLI Vision work together to provide world-class eye care that improves lives. SVP, our management services organization, supports one of the nation's largest multi-specialty ophthalmology networks.

With nearly 1,400 employees, we support more than 50 ophthalmology clinics and five state-licensed ambulatory surgery centers across New York, New Jersey, Connecticut, Pennsylvania, and West Virginia. Our network includes more than 110 physicians, surgeons, and advanced practice providers delivering exceptional eye care to our patients.

We're looking for a detail-oriented Credentialing & Provider Enrollment Specialist to join our Central Business Office team. If you thrive in a fast-paced healthcare environment, enjoy managing complex processes, and have experience with provider credentialing and payer enrollment, we'd love to hear from you.

The Credentialing & Provider Enrollment Specialist is responsible for managing the full lifecycle of provider credentialing and enrollment to ensure providers are credentialed, enrolled, and reimbursable with commercial insurance plans, Medicare, Medicaid, and other payers.

This role partners closely with providers, practice leadership, payers, and internal departments to maintain compliance, prevent enrollment delays, and support uninterrupted patient care and revenue cycle operations.

• Manage provider credentialing, recredentialing, and enrollment with commercial, Medicare, Medicaid, and government payers.
• Prepare, submit, and track credentialing and enrollment applications through approval.
• Verify provider licenses, certifications, education, training, work history, malpractice coverage, and other required documentation.
• Monitor expiration dates and coordinate timely renewals for licenses, certifications, DEA registrations, and payer participation.
• Maintain accurate provider records within credentialing databases and internal systems.
• Serve as the primary liaison between providers, insurance carriers, credentialing organizations, and internal departments.
• Research and resolve credentialing and enrollment issues to minimize reimbursement delays.
• Ensure compliance with NCQA, CMS, state regulations, and payer credentialing requirements.
• Maintain organized documentation and audit-ready credentialing files.
• Support provider onboarding by completing credentialing requirements prior to start dates.
• Assist with special projects and process improvement initiatives as assigned.

• High school diploma or equivalent required.
• Associate's or Bachelor's degree in Healthcare Administration or a related field preferred.
• Minimum 2 years of healthcare credentialing and provider enrollment experience.
• Working knowledge of commercial insurance, Medicare, and Medicaid credentialing processes.
• Proficiency with Microsoft Office, including Excel and Outlook.
• Strong organizational skills with exceptional attention to detail.
• Ability to prioritize multiple projects while meeting deadlines.

• Experience within a Central Business Office (CBO) or multi-site healthcare organization.
• Experience credentialing physicians, advanced practice providers, and ancillary providers.
• Familiarity with CAQH, PECOS, NPPES, and payer portals.
• Knowledge of NCQA, CMS, and state credentialing regulations.
• Excellent customer service and communication skills.

• Provider Credentialing & Enrollment
• CAQH, PECOS & NPPES Management
• Medicare, Medicaid & Commercial Payer Enrollment
• Credentialing Compliance
• Documentation Management
• Attention to Detail
• Time Management
• Problem Solving
• Microsoft Office Suite
• Relationship Building
• Written & Verbal Communication
• Multi-tasking in a Fast-Paced Environment