Organization Summary

Ophthalmic Consultants of the Capital Region provides a comprehensive model of eye care with experienced specialists, ophthalmologists, optometrists, and opticians providing patient-centered eye expertise in Albany, Clifton Park, Schenectady, Schodack, and Troy. Whether a patient is visiting us for a routine visit, to treat a common eye condition or has a more serious eye disorder, we endeavor to provide the highest standard of comprehensive eye care services with excellence and compassion that will consistently exceed expectations. It is a simple philosophy that we hold true—patient first in everything we do.

Position Summary:

The Credentialing Specialist position will be responsible for all aspects of the credentialing, re-credentialing and the privileging processes for all medical providers who provide patient care for Ophthalmic Consultants of the Capital Region. This role maintains up-to-date data for each provider in credentialing databases and online systems as well as ensure timely renewal of licenses and certifications.

Essential Duties & Responsibilities:

• Compile and maintain current and accurate data for all providers.
• Complete provider payer enrollment applications; monitor applications and follows-up as needed.
• Communicate with providers and external organizations to obtain necessary documentation and resolve any credentialing issues.
• Maintain copies of current state licenses, DEA certifications, malpractice coverage and any other required credentialing documents for all providers.
• Maintain knowledge of current health plan and agency requirements for credentialing providers.
• Set up and maintain provider information in credentialing databases and systems.
• Track license and certification expirations for all providers to ensure timely renewals.
• Ensures practice addresses are current with health plans, agencies, and other entities.
• Track license, DEA and professional liability expirations for providers.
• Audit health plan directories for current and accurate provider information.
• Provide credentialing and privileging verifications.
• Assist with audits and accreditation processes related to provider credentialing.
• Assist in the development and implementation of credentialing policies and procedures.
• Maintain confidentiality and adhere to HIPAA and other healthcare regulations.
• Travel to office locations and external facilities may be required for credentialing purposes.
• Support medical records and billing department, as deemed necessary, by management.
• Perform other administrative duties as needed/assigned.

Required Minimum Qualifications:

• High school diploma or equivalent.
• Minimum three years’ experience in healthcare credentialing.
• Software proficiency, specifically with Microsoft Office, and Electronic Medical Records (EMR) applications.
• Knowledge of credentialing standards and regulations, including The Joint Commission (TJC), National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicare Services (CMS) requirements.
• Knowledge of medical terminology, coding/abbreviations and medical office procedures.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Excellent analytical, organizational and time management skills.
• Keen attention to detail to maintain accurate records.
• Valid driver’s license.

Preferred Qualifications:

• College degree in related or relevant field.
• Four or more years’ experience in healthcare credentialing.
• Certified Provider Credentialing Specialist (CPCS).

Additional Information:

This position requires work to be performed on-site and occasional travel to one or more of our medical office locations. All applicants must be legally authorized to work in the United States.

Compensation and Benefits:

Ophthalmic Consultants of the Capital Region offers competitive pay and a comprehensive benefits package for full-time employees including medical, dental and vision coverage, flexible spending and dependent care accounts, as well as a wide array of voluntary benefit offerings such as disability, life and critical illness insurance. Full-time employees also enjoy generous paid time off including seven (7) paid holidays and a 401k plan with employer contribution.

Ophthalmic Consultants of the Capital Region is an Equal Opportunity Employer and does not discriminate against any protected class of job applicant or employee in our hiring and employment practices. Compensation offers are based on experience, skills, and education. Benefits and benefit eligibility can vary by position, and exclusions may apply for some roles.