Payor Credentialing Specialist

Job Description

Job Description

Description: Our mission is to provide quality, accessible and patient-centered eye care.

Consider joining Ascend Vision Partners and join a team that are focused on building a differentiated integrated eye care platform focused on superior patient care delivered through our network of optometrists and ophthalmologists. Team members are expected to exhibit a continuous behavior of professionalism, which includes but is not limited to, acting with integrity and accountability, support our clinicians in all aspects of patient care delivery, support a culture of respect, diversity and inclusion in our organization, and enhance the patient access to primary and specialty eye care. 

Our vision is to create an admired healthcare company dedicated to delivering personalized eye care with outstanding patient outcomes. 

JOB SUMMARY:

The Payor Credentialing Specialist, will be responsible for ensuring our healthcare providers are accurately credentialed and compliant with payor requirements. The position will manage the credentialing process, maintain up-to-date documentation and facilitate communication between healthcare providers and insurance companies. 

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Manage and process credentialing applications for healthcare providers with insurance payors.
• Verify and update provider information in credentialing databases and systems.
• Maintain compliance with state, federal, and organizational credentialing requirements.
• Communicate with insurance companies, providers, and internal staff to resolve credentialing issues.
• Track credentialing status and ensure timely completion of applications and renewals.
• Prepare and submit necessary documentation for initial credentialing and recredentialing processes.
• Conduct regular audits of credentialing files to ensure accuracy and completeness.
• Serve as a point of contact for inquiries regarding credentialing status and requirements.
• Develop and maintain strong relationships with payors and external credentialing bodies.
• Collaborate with internal departments to facilitate smooth onboarding and credentialing of new providers.
• Ensure confidentiality and security of all provider information and credentialing documentation.
• Stay updated on changes in credentialing regulations and industry standards.
• Assist in the development and implementation of credentialing policies and procedures.
• Generate and analyze reports on credentialing metrics and performance indicators.

Requirements:

REQUIREMENTS:

• High school diploma or equivalent; associate or bachelor’s degree preferred.
• Minimum of 2 years of experience in healthcare credentialing or payor enrollment.
• Comprehensive understanding of credentialing processes and payor requirements.
• Proficiency in credentialing software and Microsoft Office Suite.
• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and meet deadlines.
• Excellent communication and interpersonal skills.
• Familiarity with healthcare regulations and compliance standards.
• Experience with data entry and maintaining accurate records.
• Strong problem-solving skills and analytical abilities.
• Ability to work independently and as part of a team.
• Knowledge of healthcare terminology and documentation practices.