What are the responsibilities and job description for the Credentialing Coordinator position at Partners Insight?
Our client, is a leading provider of comprehensive eye care services, dedicated to enhancing vision and eye health.
They are seeking a Credentialing Coordinator to lead and manage the credentialing process for our team of Optometrists across multiple locations. This role ensures that all providers are properly credentialed with major vision and medical payors, covering both professional services and retail services such as spectacles and contact lenses.
The ideal candidate will possess strong organizational skills, a proactive approach to resolving contracting issues, and a commitment to maintaining compliance with HIPAA and NCQA standards. This position is critical to ensuring the timely onboarding of providers and maintaining active participation status with all contracted payors.
Key Responsibilities
Credentialing & Recredentialing:
- Manage the full lifecycle of credentialing and recredentialing for all providers, including optometrists and ophthalmologists.
- Ensure credentialing with major vision payors (e.g., VSP, EyeMed, Davis Vision) and medical plans (e.g., Medicare, Medicaid, commercial insurers) for both clinical and retail services.
- Maintain up-to-date knowledge of payor-specific credentialing requirements and timelines.
- Coordinate with providers to collect necessary documentation, including licenses, certifications, malpractice insurance, and DEA/NPI numbers.
- Assist providers with CAQH profile management, including updates and attestations prior to expiration.
- Track and manage expirables (e.g., licenses, insurance, certifications) to ensure uninterrupted participation.
- Actively follow up with payors to resolve outstanding contracting issues, delays, or denials.
- Serve as the primary liaison between client and payors/MSOs to ensure timely credentialing and contracting.
- Escalate unresolved issues to leadership and collaborate with legal or compliance teams as needed.
- Monitor and report on contracting status, including pending applications, effective dates, and participation status.
- Maintain accurate and organized electronic credentialing files and databases.
- Prepare and present credentialing status reports, KPIs, and dashboards to leadership on a regular basis.
Track Key Performance Indicators (KPIs):
- Average time to credential
- CAQH updates
- Number of providers credentialed per month
- Payor approval turnaround times
- Recredentialing compliance rates
Cross-Functional Coordination:
- Communicate credentialing timelines, requirements, and updates clearly to providers and internal stakeholders.
- Coordinate with HR, Operations, and Billing teams to ensure credentialing aligns with onboarding and billing readiness.
- Establish and onboard payor portal logins for the Operations and Billing teams.
- Provide credentialing status updates to the Revenue Cycle and Billing teams to avoid claim denials due to credentialing issues.
- Ensure timely and professional responses to internal and external inquiries regarding credentialing.
Compliance & Continuous Improvement:
- Ensure compliance with HIPAA, NCQA, OIG, and other regulatory standards.
- Stay current on industry changes and payor updates that impact credentialing and contracting.
- Assist in audits and compliance reviews related to provider credentialing.
- Prepare credentialing packets, rosters, and applications for submission to payors.
- Develop and maintain credentialing SOPs and training materials.
- Support leadership with special projects and initiatives related to provider onboarding and network expansion.
Requirements
- High school diploma or GED required; Associate’s or Bachelor’s degree preferred.
- Minimum of 2–3 years of experience in healthcare credentialing, preferably in optometry or ophthalmology.
- Strong understanding of credentialing processes for both medical and vision payors.
- Experience with CAQH, PECOS, and credentialing software platforms.
- Excellent organizational and time management skills.
- Strong verbal and written communication skills.
- Ability to work independently and collaboratively in a fast-paced environment.
- Proficiency in MS Office (Excel, Word, Outlook) and database management.
Preferred Qualifications
- Experience with electronic medical records (EMR).
- Familiarity with credentialing for retail services (e.g., optical dispensary billing).
- Knowledge of Compulink or similar optometry practice management software.
We Offer
- Competitive salary commensurate with experience.
- Comprehensive benefits package including medical, dental, and vision insurance.
- Company-paid short-term and long-term disability coverage.
- Company-paid life insurance policy.
- 401(k) plan
- Potential for quarterly bonuses based on performance.
