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Description

Position Summary

The Credentialing Specialist is responsible for managing the full lifecycle of professional and facility (Ambulatory Surgery Center) provider credentialing and enrollment activities across the enterprise. This role owns key compliance functions including license and certificate renewals, hospital and ASC privilege management, reappointment processes, expirables tracking, and cross-functional support for RCM and Operations teams. The ideal candidate is detail-oriented, proactive, and comfortable managing multiple concurrent deadlines in a fast-paced healthcare environment.

Essential Functions and Responsibilities

• Complete new provider hospital and ASC medical staff applications, including initial credentialing and privileging submissions
• Manage reappointment applications for hospitals and ASCs; monitor reappointment dates and initiate process within 90 days of due date, updating in Credentialing Management system upon completion
• Ensure hospitals and ASCs have current professional provider licenses, certificates, and supporting documentation
• Serve as the primary point of contact for hospital and ASC medical staff office inquiries
• Monitor and track provider license, DEA, CME, and CLIA certificate expiration dates in Credentialing Management System
• Send renewal notices to providers and clinic managers 60 days prior to expiration; follow up until renewed documents are received
• Assist providers with state license and DEA renewal processes as needed
• Upload all renewed licenses and certificates to Credentialing Management System upon receipt; update expiration date
• Conduct monthly review of all provider expirables at the beginning of each month; flag urgent items at risk for expiration to leadership
• Maintain CME records for providers via CE Broker; monitor and report as required for hospital privileges and state license requirements
• Facilitate malpractice applications as directed
• Record malpractice carrier in each provider’s profile in Credentialing Management System
• Distribute updated certificates of insurance (COIs) to hospitals, ASCs, and payers upon request or receipt
• Maintain accurate COI records in Credentialing Management System and CAQH
• Assist with malpractice-related communications and documentation as directed
• Initiate and track background screening submissions dictated by state requirements or license renewals as directed
• Upload results to Credentialing Management System and report outcomes to manager
• Process requests for provider / practice information from payors or third party administrators as directed
• Serve as liaison between payor representatives and credentialing team as directed
• Work collaboratively with associated credentialing vendors as directed
• Respond to daily RCM, Contact Center and Operations teams’ inquiries related to provider credentialing, insurance participation, and directory information
• Attend cross-functional meetings as needed to resolve credentialing-related issues
• Assist with maintenance of provider insurance directories used as reference documents for RCM and Ops teams
• Assist with claims denials research, tasking and resolution related to credentialing
• Maintain accurate and up-to-date provider data in Credentialing Management System including profiles, documents, expiration dates, and privilege/reappointment information
• Follow established SOPs for credentialing functions; contribute to SOP development and updates as directed
• Support department tracking and reporting as assigned

Benefits

As a team member at Eye Health America, you'll enjoy:

• Medical, Dental, Vision, Short-term Disability, Long-term Disability, Life Insurance, etc.
• Matching 401(k)
• Employee Discount
• Wellness Program
• Paid Vacation & Holidays
• Uniform Allowance
• Training/Advancement opportunities

About Us

At Eye Health America, we support the expansion of leading eye care practices across the Southeastern United States through both organic growth and strategic partnerships. Led by an experienced team of eye care industry leaders with more than 100 years of combined practice management experience, we partner with best-in-class practices and ambulatory surgery centers to deliver full-service, integrated eye care. Our focus is to provide the operational, strategic, and administrative support that allows our providers and teams to stay focused on what matters most—delivering exceptional clinical care and an outstanding patient experience. Together, we are building a network of trusted practices dedicated to meeting the growing demand for high-quality eye care while making a meaningful impact in the communities we serve.

Our Purpose

Making lives better with personalized eyecare.

Our Values

People-Focused - Our people are the secret to our success. We are defined by our shared values and demonstrate them in every interaction. They guide us and ensure we are in an inclusive place where our teammates love to work, and our patients are delighted to visit.

Heartfelt Service - With helpful hands and open minds and hearts, we actively engage with our individual locations, celebrating their unique local style, while identifying solutions to support improved service.

Mutual Respect - We share ideas, collaborate, and troubleshoot as a team, seeking alignment in decision-making. By supporting and equitably empowering one another, we discover new ways to create value.

Honesty & Transparency - We act with integrity and transparency without fear of speaking up or disrupting the status quo. We communicate clearly and respectfully with everyone.

Result-Oriented - Analysis improves our decision-making. We strive to track all facets of our business to develop insights for improved care. Best performance is derived from strong leadership, setting goals, executing plans, monitoring results, and reinforcing successful approaches.

Growth Mindset - We seek to grow our people, services, markets, and overall company to create value. Always looking forward, we explore new technologies, treatments, systems, and processes for improvement.

Requirements

• 2+ years of experience in healthcare credentialing, medical staff services, or a related role
• Proficiency with CAQH, PECOS, NPPES
• Experience with direct payor credentialing processes
• Working knowledge of hospital and ASC credentialing and privileging processes
• Experience with provider reappointment processes and medical staff office requirements
• Familiarity with state licensing processes
• Familiarity with navigating practice management system(s)
• Strong organizational skills with the ability to manage multiple concurrent deadlines
• Proficiency with Microsoft Office (MS Excel, MS Word, MS Power Point) and credentialing
• High attention to detail and accuracy
• Excellent written and verbal communication skills
• Ability to thrive in a fast-paced, high-volume environment with shifting priorities

Preferred:

• 5+ years of experience in healthcare credentialing
• Experience credentialing providers in Florida, Georgia or South Carolina
• Education level Associates or higher
• Experience with Modio or similar credentialing management platform
• Familiarity with Smartsheet or similar project management tools
• Experience in ambulatory surgery center, ophthalmology, optometry, or multi-specialty physician group environment