Credentialing Specialist

Comprehensive EyeCare Partners (CompEye), with twelve ophthalmology practices across Nevada, Washington, Texas, and Utah, is a leader in delivering exceptional patient eye care. All CompEye practices and teammates subscribe to the following Values and Beliefs:

• Patient Focused : Delivering excellent clinical care is our central purpose. In all we do, we consider the impact on patient safety, clinical outcomes, and patient experience.
• One Team : We work together collaboratively to get the job done, regardless of role or department. We are all CompEye. We are "one team."
• Compassion & Kindness : We treat others-including patients, teammates, and partners-the way we'd like to be treated, with active listening and understanding.
• Continuous Innovation : We actively seek ways to improve ourselves, the care we deliver, the clinical innovations that support patients, and how we manage the business.
• Integrity : We do the right thing even and especially when it's hard. We hold ourselves accountable.
• Results Driven : We deliver with a healthy sense of urgency on what we commit to and do what it takes to get the job done.

Position Summary

The Credentialing Specialist will provide operational and administrative support to the Regional Credentialing Team across multiple regions and practices. This role is responsible for maintaining provider data accuracy, assisting with payer-related updates, supporting onboarding workflows, and ensuring credentialing maintenance tasks are completed in a timely and organized manner.

Roles and Responsibilities

• Coordinate and submit quarterly insurance directory roster updates for providers and practices across all applicable insurance companies and regions.
• Maintain accurate provider demographic information to support payer compliance and patient access.
• Update and maintain provider information within payer portals as required.
• Manage provider attestations for credentialing databases including CAQH and ProviderSource.
• Verify provider information, upload required documentation, and complete attestations within required timeframes.
• Assist with maintenance and updates for Insurance Grid projects across all regions.
• Collaborate with practice leadership and operational staff to maintain accurate insurance participation information.
• Perform data entry and ongoing maintenance within credentialing software systems.
• Ensure provider records, credentialing statuses, and timelines remain accurate and up to date.
• Assist with maintenance and development of project boards via Monday.com for operational tracking and visibility.
• Assist with time-sensitive credentialing and administrative requests as needed.
• Communicate professionally with payer representatives via phone and email regarding credentialing matters.
• Other duties as assigned

Experience Requirements

• Minimum of three (3) years of credentialing experience required.
• Clear understanding of payer enrollment and credentialing process is required.
• Familiarity with CAQH, Availity, payer portals, and credential databases is required.
• Proficiency in Microsoft suite products: Excel, Word, PowerPoint, and Outlook is required.
• Proficient in Adobe Acrobat and DocuSignis preferred
• Experience with Monday.com or similar workflow/project management platforms preferred
• Strong organizational and multitasking skills with high attention to detail
• Comfortable communicating with insurance payers and provider offices via phone and email
• Excellent written and verbal communication skills
• Ability to work independently and prioritize tasks in a fast-paced environment.
• Ability to maintain professionalism and confidentiality while handling sensitive provider information.
• Ability to professionally conduct payer follow-up and escalation calls regarding credentialing and enrollment statuses.

Education Requirements

• High School Diploma or equivalent required
• Bachelor's degree preferred
• Certified Provider Credentialing Specialist (CPCS) preferred.

Physical Demands

The physical demands described here are representative of those that must be met by an employee 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 employee is primarily required to sit for extended periods, use hands for typing and operating computer equipment, and talk or hear while communicating with callers. The employee may occasionally be required to stand or walk within the call center environment. The employee must have the ability to maintain focus and concentrate on tasks amidst potential distractions. Specific vision abilities required by this job include close vision for reading and distance vision for viewing computer screens. The physical demands of this position typically involve minimal lifting or carrying of objects, not exceeding 10 pounds.