Credentialing Assistant

Job Title: Dental Credentialing Specialist

Location: Remote

Job Type: Full-time

Reports To: Credentialing Manager

Job Overview:

The Dental Credentialing Specialist is responsible for managing the credentialing and re-credentialing process for dental providers with various insurance companies, ensuring compliance with state, federal, and company regulations. This role ensures accurate and timely submission of credentialing applications, tracks progress, and maintains communication with insurance carriers and providers to facilitate a seamless process.

Key Responsibilities:

• Credentialing Applications: Prepare, submit, and track credentialing and re-credentialing applications for dental providers to various insurance carriers.
• Verification: Verify licenses, certifications, education, and professional references for dental providers, ensuring all documentation meets the requirements of insurance carriers and regulatory bodies.
• Documentation Maintenance: Maintain provider files with up-to-date information, including licenses, certifications, insurance documentation, and other relevant records.
• Regulatory Compliance: Ensure all credentialing activities comply with federal and state regulations, as well as specific payer requirements.
• Provider Communication: Act as the primary contact for providers and field offices, addressing credentialing matters and providing updates on the credentialing process.
• Carrier Follow-up: Regularly follow up with insurance carriers and credentialing partners to ensure timely approval of applications.
• Stakeholder Communication: Provide updates on credentialing status to internal stakeholders and keep providers informed of progress or requirements.
• Database Management: Maintain an organized, accurate, and secure database of provider credentialing information.
• Renewal Tracking: Track renewal dates for licenses and certifications, notifying providers of upcoming expirations to ensure uninterrupted participation.
• Process Improvement: Identify opportunities to streamline the credentialing process for increased efficiency and accuracy.
• Policy Development: Assist in developing and updating credentialing policies and procedures as necessary to ensure consistency and compliance with industry standards.

Qualifications:

• Education: High school diploma or equivalent required.
• Experience: Previous experience in dental or medical credentialing is required.
• Knowledge: Familiarity with insurance networks, payer requirements, and provider enrollment processes is essential.
• Skills:
• • Excellent organizational and time-management skills.
  • Strong attention to detail and accuracy.
  • Proficient in Microsoft Office Suite (Word, Excel, Outlook) and credentialing software.
  • Effective verbal and written communication skills.
• Additional Knowledge: Understanding dental terminology and procedures is a plus. Knowledge of HIPAA compliance and state/federal healthcare regulations is required.

Working Conditions:

• This is a work-from-home position                  
• Occasional overtime may be required to meet deadlines or manage high workloads.