Credentialing Specialist

2 weeks ago

Hauppauge, United States SightMD Full time
A career that changes lives.

SightMD is a rapidly growing integrated ophthalmic provider group, extending the reach of exceptional eye care to patients across New York, New Jersey, Pennsylvania, and Connecticut. With over 127 eye care providers and the convenience of 60 locations, our commitment to delivering unparalleled services is at the heart of everything we do. As we embark on our mission, we are actively seeking teammates who are eager to contribute to our legacy of eye excellence, a tradition that spans more than 50 years.

Position Summary:

The Credentialing Specialist is responsible for all aspects of the credentialing, re-credentialing, and privileging processes for providers in the practice.The Specialist is responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and Ambulatory Surgical Centers (ASCs).The Specialist will also maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.

Job Duties & Essential Functions:
  • Completes provider enrollment and re-credentialing applications for all state Medicaid insurance plans.
  • Ensures the timelines for provider enrollment to insurance payers.
  • Tracks all provider enrollment and participation with effective dates, ID numbers and billing status.
  • Researches and resolves all provider enrollment issues.
  • Audits Commercial and Medicaid plan directories for current and accurate provider information
  • Maintains confidentiality of provider data.
  • Provides back-up coverage for Coordinator/ Specialist.
  • Performs other duties as assigned.
Required Qualifications:
  • 2 years of credentialing experience.
  • Ability to communicate effectively, both orally and in writing.
  • Strong organizational skills.
  • CAQH and AVAILITY experience.
  • Ability to work independently with minimal supervision.
  • Ability to work in a fast-paced environment with multiple completing deadlines.
Preferred Qualifications:
  • Knowledge of state Medicaid regulations and guidelines
Work Schedule:
  • Monday to Friday: 9am to 5pm
  • Hybrid
Salary Range:
  • $60,000 to $65,000
Benefits:

We aim to take care of our teammates the same way we take care of our patients. All SightMD employees receive the following benefits:
  • Medical/Dental/Vision Insurance
  • Prescription Drug Coverage
  • Company Paid Term Life Insurance & Long-Term Disability
  • Supplemental Insurance Benefits
  • Employee Assistance Program (EAP)
  • Retirement Plan - 401(k)
  • Paid Time Off (PTO)
  • Paid Holidays
  • Career Development Programs

* All benefits are subject to eligibility requirements.

Equal Employment Opportunity Statement:

SightMD is an equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal, state and local laws.

If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact People Services at peopleservices@sightgrowthpartners.com

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