Credentialing Specialist

The Credentialing Specialist will ensure all new dental providers are credentialed and re-credentialed with appropriate payers as needed. This position will be the liaison between payers and the field, reporting to the Director of Credentialing and Provider Enrollment. This position maintains a high level of confidentiality, attention to detail, professionalism, and reporting.
The Credentialing Specialist's Duties and Responsibilities include but are not limited to:
• Perform provider credentialing/qualifying process to ensure all requirements are met following NCQA standards
• Assist in the credentialing process by entering/logging/scanning information into the credentialing system for initial, updating, and add-on applications and maintenance processes
• Ensure that all information meets guidelines when processing applications
• Enrolling Dental providers in various insurance and discount plans
• Have professional working relationships and communication with facilities in which providers practice
• Work directly with the providers to complete all phases of the credentialing process
• Tracks license and certification expirations for all providers
• Maintains confidentiality of provider information
• Keep up with compliance, regulatory, and state requirements.
• Assist in managing departmental projects
• All other departmental duties as assigned
Knowledge, Skills & Abilities:
• Excellent computer skills
• Proficient in Microsoft Office, including Excel and PowerPoint
• Excellent verbal and written communication skills
• Highly organized, conscientious individual with the ability to manage multiple responsibilities at once
• Must be able to work in a fast-paced environment
• Self-motivated individual who is adaptable to change
• Ability to work under minimal supervision
• Ability to establish and maintain positive and effective work relationships
• Proficient knowledge in credentialing dental and/or medical doctors
• Ability to organize and prioritize multiple tasks
• Ability to follow routine processes and procedures consistently and efficiently.
Education & Experience: • Bachelor's Degree in Business or Healthcare management preferred.
• Experience in Dental Credentialing preferred but not required.
• Experience in Provider Enrollment
• Experience with credentialing software