Credentialing Specialist

Credentialing Specialist (Revenue Cycle)

The Credentialing Specialist (Revenue Cycle) will serve to support all insurance payor relationships, including provider credentialing and enrollments, with the goal to establish stronger positions in markets represented by Specialized Dental Partners (SDP) in various dental specialties.

Responsibilities:

Serve to support overall relationship with insurance payors.

Collaborate with practices to plan, strategize and support insurance payor credentialing needs.

Support all provider credentialing and re-credentialing activities in a manner that mitigates the risk of financial losses, coordinate efforts with operational leaders through the on boarding process.

Maintain provider files, payor participation information, including expirable documents.

Complete all applications for payor credentialing and re-credentialing in a timely manner; obtain appropriate documents from various resources to complete payer applications, as needed.

Assist to identify, and resolve timely, any payor enrollment-related under-payment / non payments.

Assist to develop SOPs, training, and development of new colleagues on payor contracts.

Communicate with other departments within the Practice Support Services, & practice-based teams.

Other duties as assigned.

Qualifications:

Experience:

• High school diploma or GED
• 2+ years of experience working in a Dental practice or a DSO
• 2+ years of experience creating pivot tables, using V-lookups, and formulas in Microsoft Excel
• 2+ years of experience doing fee schedule analysis
• 2+ years of experience in CAQH and NPI management
• 2+ years of experience working in data management systems and insurance networks

Specialized Dental Partners, its affiliates, related companies and independently owned supported clinical practices are proud to be Equal Opportunity Employers. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

The salary range for this role is $45,000 - $55,000 per year. At Specialized Dental Partners, its affiliates, related companies and independently owned supported clinical practices, we are committed to ensuring fair and equitable pay for all employees. We adhere to all applicable federal, state, and local laws regarding pay equity and non-discrimination. Our compensation practices are designed to ensure that employees are paid fairly based on their role, experience, performance, and contributions to the company, without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. We regularly review our compensation practices and conduct pay equity audits to identify and address any disparities. By fostering a culture of transparency and fairness, we aim to create an inclusive workplace where all employees feel valued and respected.