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Credentialing Spectrum Jobs in New York (NOW HIRING)

The Doula Network

Doula (New York)

New York, NY · On-site

We're building a network of experienced birth and full-spectrum doulas to educate and guide ... Credentialing process & next steps: Once you apply, our team will guide you through the ...

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Credentialing Spectrum information

What is the difference between Credentialing Spectrum vs Medical Coder?

AspectCredentialing SpectrumMedical Coder
Required credentialsCertifications like CPC, CCS, or equivalent; licensing may varyCertifications such as CPC, CCS, or CRC; often required
Work environmentHealthcare facilities, insurance companies, credentialing agenciesHospitals, clinics, physician offices, insurance companies
Industry usageUsed in credentialing, provider verification, complianceUsed in medical billing, coding, and documentation

Credentialing Spectrum and Medical Coder roles share certifications and work in healthcare settings, but Credentialing Spectrum focuses on provider verification and credentialing processes, while Medical Coders handle medical documentation and billing. Both are essential in healthcare operations but serve different functions.

Is credentialing spectrum a hard job?

Credentialing specialists, including those working in credentialing spectrum roles, often find the job challenging due to the detailed documentation, compliance requirements, and attention to accuracy involved. The role requires strong organizational skills, knowledge of healthcare or industry regulations, and the ability to manage multiple tasks within deadlines. While it can be demanding, it is manageable with proper training and experience.

What are popular job titles related to Credentialing Spectrum jobs in New York?

For Credentialing Spectrum jobs in New York, the most frequently searched job titles are:

What job categories do people searching Credentialing Spectrum jobs in New York look for?

The top searched job categories for Credentialing Spectrum jobs in New York are:

What cities in New York are hiring for Credentialing Spectrum jobs?

Cities in New York with the most Credentialing Spectrum job openings:

Credentialing Spectrum jobs near you

Provider Credentialing Specialist (Healthcare)

OCLI Vision

Uniondale, NY • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Provider Credentialing Specialist
Supporting Spectrum Vision Partners' OCLI Vision & Ambulatory Surgery Centers
Schedule: Standard full-time schedule, Monday through Friday. Hybrid - 3 days onsite and 2 days remote/work from home each week.
Who We're Looking For
Spectrum Vision Partners (SVP) and OCLI Vision work together to provide world-class eye care that improves lives. SVP, our management services organization, supports one of the nation's largest multi-specialty ophthalmology networks.
With nearly 1,400 employees, we support more than 50 ophthalmology clinics and five state-licensed ambulatory surgery centers across New York, New Jersey, Connecticut, Pennsylvania, and West Virginia. Our network includes more than 110 physicians, surgeons, and advanced practice providers delivering exceptional eye care to our patients.
We're looking for a detail-oriented Credentialing & Provider Enrollment Specialist to join our Central Business Office team. If you thrive in a fast-paced healthcare environment, enjoy managing complex processes, and have experience with provider credentialing and payer enrollment, we'd love to hear from you.
Job Summary
The Credentialing & Provider Enrollment Specialist is responsible for managing the full lifecycle of provider credentialing and enrollment to ensure providers are credentialed, enrolled, and reimbursable with commercial insurance plans, Medicare, Medicaid, and other payers.
This role partners closely with providers, practice leadership, payers, and internal departments to maintain compliance, prevent enrollment delays, and support uninterrupted patient care and revenue cycle operations.
What You'll Do
  • Manage provider credentialing, recredentialing, and enrollment with commercial, Medicare, Medicaid, and government payers.
  • Prepare, submit, and track credentialing and enrollment applications through approval.
  • Verify provider licenses, certifications, education, training, work history, malpractice coverage, and other required documentation.
  • Monitor expiration dates and coordinate timely renewals for licenses, certifications, DEA registrations, and payer participation.
  • Maintain accurate provider records within credentialing databases and internal systems.
  • Serve as the primary liaison between providers, insurance carriers, credentialing organizations, and internal departments.
  • Research and resolve credentialing and enrollment issues to minimize reimbursement delays.
  • Ensure compliance with NCQA, CMS, state regulations, and payer credentialing requirements.
  • Maintain organized documentation and audit-ready credentialing files.
  • Support provider onboarding by completing credentialing requirements prior to start dates.
  • Assist with special projects and process improvement initiatives as assigned.
Minimum Qualifications
  • High school diploma or equivalent required.
  • Associate's or Bachelor's degree in Healthcare Administration or a related field preferred.
  • Minimum 2 years of healthcare credentialing and provider enrollment experience.
  • Working knowledge of commercial insurance, Medicare, and Medicaid credentialing processes.
  • Proficiency with Microsoft Office, including Excel and Outlook.
  • Strong organizational skills with exceptional attention to detail.
  • Ability to prioritize multiple projects while meeting deadlines.
Preferred Qualifications
  • Experience within a Central Business Office (CBO) or multi-site healthcare organization.
  • Experience credentialing physicians, advanced practice providers, and ancillary providers.
  • Familiarity with CAQH, PECOS, NPPES, and payer portals.
  • Knowledge of NCQA, CMS, and state credentialing regulations.
  • Excellent customer service and communication skills.
Skills for Success
  • Provider Credentialing & Enrollment
  • CAQH, PECOS & NPPES Management
  • Medicare, Medicaid & Commercial Payer Enrollment
  • Credentialing Compliance
  • Documentation Management
  • Attention to Detail
  • Time Management
  • Problem Solving
  • Microsoft Office Suite
  • Relationship Building
  • Written & Verbal Communication
  • Multi-tasking in a Fast-Paced Environment

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