Job Overview
We are seeking a detail-oriented Credentialing & Audit Specialist to join our growing eye care practice. This dual-role position manages the complete provider credentialing lifecycle for our Optometrists (ODs) and Ophthalmologists (MDs/DOs). You will also execute internal audit reviews to ensure full compliance with vision care plans, medical insurance payors, and regulatory standards.
Key Responsibilities
Provider Credentialing & Payor Enrollment
- Process primary source verification for all incoming Optometrists and Ophthalmologists.
- Manage enrollment with major vision plans (e.g., VSP, EyeMed, Davis Vision) and medical payors (Medicare, Blue Cross, etc.).
- Track expirations for state optometry/medical licenses, DEA certificates, and board certifications.
- Maintain accurate provider profiles within CAQH and internal practice databases.
- Resolve payor enrollment delays to prevent claim rejections and disruptions to patient care.
Audit & Quality Reviews
- Conduct routine internal audits on clinical documentation and billing codes for compliance.
- Review patient charts to ensure accurate usage of vision insurance vs. medical insurance benefits.
- Identify discrepancies, missing provider signatures, or compliance gaps in electronic health records (EHR).
- Prepare comprehensive audit reports detailing findings, coding trends, and risk areas.
- Recommend corrective training and action plans to improve clinical documentation workflows.
Qualifications & Skills
- Location: Ability to work reliably on-site at our Vestavia, AL office.
- Experience: Minimum 2–3 years in healthcare credentialing, ideally within an eye care or specialty practice.
- Knowledge: Deep understanding of both vision care networks and medical insurance payors.
- Tech Skills: Experience with Eyecloud Pro or Eyefinity (EHR/PM) is highly preferred; experience navigating an EHR system transition is a major plus.
- Certifications: CPCS (Certified Provider Credentialing Specialist) or medical auditing credentials (e.g., CPMA) are highly preferred.
- Attributes: Exceptional attention to detail and strong analytical thinking.
Pay: $18.00 - $20.00 per hour
Benefits:
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Referral program
- Retirement plan
Work Location: In person
