Credentialing Assistant – Ophthalmology & Optometry

Position Summary

The Credentialing Assistant is responsible for supporting all aspects of provider credentialing, recredentialing, and payer enrollment for physicians, optometrists, advanced practice providers, and ancillary clinical staff. This role ensures providers are credentialed accurately and efficiently with commercial insurance carriers, Medicare, Medicaid, hospitals, surgery centers, and other healthcare organizations while maintaining compliance with federal, state, and payer requirements.

The ideal candidate has experience in ophthalmology and/or optometry credentialing and possesses exceptional organizational, communication, and problem-solving skills.

Essential Duties and ResponsibilitiesProvider Credentialing

• Prepare, submit, and monitor initial credentialing and recredentialing applications.
• Complete provider enrollment for Medicare, Medicaid, commercial insurance plans, and managed care organizations.
• Coordinate CAQH profile setup, maintenance, attestations, and updates.
• Maintain provider information within PECOS, NPPES, and state licensing portals.
• Track application status and follow up with insurance companies until approval is received.
• Maintain credentialing files for all providers and ensure documents remain current.

Licensing & Compliance

• Monitor expiration dates for:
• Medical licenses
• DEA registrations
• Controlled substance licenses
• Board certifications
• CPR/BLS certifications
• Professional liability insurance
• Coordinate renewals before expiration.
• Ensure compliance with all payer, federal, and state regulations.

Facility & Organizational Credentialing

• Assist with credentialing for:
• Ophthalmology clinics
• Optical locations
• Ambulatory Surgery Centers (ASC)
• Maintain facility enrollments with commercial and government payers.
• Coordinate provider privileges with hospitals and surgery centers.

Insurance & Payer Relations

• Communicate directly with insurance companies regarding application status.
• Resolve enrollment delays, denials, and credentialing discrepancies.
• Maintain knowledge of payer-specific credentialing requirements.
• Assist providers with participation changes and contract updates.

Database Management

• Maintain electronic credentialing databases.
• Organize digital provider files.
• Generate credentialing reports for leadership.
• Track upcoming expirations and recredentialing deadlines.

Administrative Support

• Prepare provider onboarding packets.
• Collect required documentation from providers.
• Assist Human Resources during provider onboarding.
• Support practice administrators with credentialing projects.
• Maintain strict confidentiality of provider information.

QualificationsRequired

• High school diploma or equivalent.
• Minimum of 2 years of credentialing experience in a medical practice.
• Experience working with Medicare, Medicaid, and commercial insurance credentialing.
• Knowledge of CAQH, PECOS, and NPPES.
• Strong computer skills including Microsoft Office.
• Excellent organizational and time management skills.
• Strong written and verbal communication skills.
• Ability to manage multiple deadlines.

Preferred

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).
• Experience credentialing ophthalmologists and optometrists.
• Experience with ambulatory surgery center (ASC) credentialing.
• Knowledge of ophthalmology billing and insurance requirements.
• Experience with electronic medical records (EMR/EHR) systems.

Knowledge, Skills & Abilities

• Thorough understanding of medical credentialing standards.
• Familiarity with CMS regulations and payer enrollment processes.
• Knowledge of ophthalmology and optometry provider credentialing requirements.
• Excellent attention to detail.
• Strong analytical and problem-solving abilities.
• Ability to maintain confidentiality and HIPAA compliance.
• Ability to work independently while managing multiple projects.
• Strong customer service and professional communication skills.

Physical Requirements

• Prolonged periods sitting at a desk.
• Frequent computer use.
• Occasional lifting of files or office materials up to 20 pounds.

Work Environment

• Medical office setting.
• Standard Monday–Friday business hours.

Performance Metrics

Success in this role will be measured by:

• Timely completion of initial credentialing applications.
• Zero provider lapses in credentialing or payer enrollment.
• Accurate maintenance of credentialing files.
• On-time license and certification renewals.
• Successful completion of payer enrollments.
• Efficient turnaround of provider onboarding.
• Compliance with all regulatory and accreditation standards.

Benefits

• Competitive salary
• Health, dental, and vision insurance
• Paid time off
• Paid holidays
• 401(k) with employer match (if applicable)

Reports To: Director of Operations and Billing Manager

Employment Type: Full-Time

Pay: $17.00 - $20.00 per hour

Benefits:

• 401(k)
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person