Credentialing Specialist

Job Title:Credentialing Specialist
Location:Remote
Duration & Type:Contract through the remainder of 2026 with potential for extension or conversion
Compensation & Benefits: Competitive W2 Hourly Rate ($20 - $22), Access to Healthcare and Dental Insurance Plan of Choice. (Benefit Plans can be requested at time of submission to client) Equipment provided, including a company-issued laptop.

Chamberlain Advisors is seeking a Credentialing Specialist for their client in the insurance industry. The Credentialing Specialist will ensure the delivery of high-quality care to members by monitoring and maintaining the integrity of dental provider data in compliance with industry standards and regulatory requirements.  They provide integral support to dental operations by enabling timely onboarding of dental providers.  Main responsibilities include interacting with dental health care providers in a professional manner to collect required data and utilization of various search functions and databases in order to perform comprehensive and detailed reviews of required licensures, certifications, background searches and training records.  Under limited supervision, this position is also responsible for processing, analyzing and delivering various reports and updates within strict deadlines.  They also work with the Credentialing and Clinical Review teams to ensure provider audits are completed in an accurate and timely manner, and may work on related special projects, as assigned.
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What You Will Be Accountable For

• Collaborates professionally with dental health care providers, offices and staff to collect relevant data to ensure accuracy of records.
• Ensures potential New Provider applications meet credentialing standards prior to being credentialed.
• Ensures accurate entry and maintenance of data utilizing various resources and search databases.
• Compiles and analyzes data to ensure completeness and accuracy of records and information.
• Displays sound judgement by escalating inaccurate and/or contradicting data to Supervisor and Clinical committees.
• Reviews and screens initial and recredentialing applications for completeness, accuracy, and compliance with federal, state, local and regulations, guidelines, policies, and standards.
• Conducts primary source verification, collects, and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to NCQA credentialing standards.
• Identifies, analyzes and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discovers and conveys problems to credentialing Manager for sound decision making in accordance with Medical Staff Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
• Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
• Enters, updates and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
• Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
• Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies and standards.
• Communicates clearly with providers, their liaisons, entity Medical Staff Affairs. medical staff leadership and Administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
• Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Processes weekly CDT reports.
• Processes bi-weekly On-Going Monitor report.
• Prepares forms and reports to be completed by Dental Director.
• Ensures monitors and maintains data integrity to ensure compliance with complex regulatory standards. within the defined timeframes.
• Participates in Credentialing Committee and other credentialing meetings.
• Sends follow up and termination correspondence to Providers after review from Dental Director and / or Credentialing Committee.
• Collect missing information via phone, fax, and/or letter from current providers in order to complete the re-credentialing process.
• Documents credentialing decisions of the Dental Director.
• Acts as subject matter expert to assist other departments with credentialing information.
• Communicates and interacts effectively and professionally with co-workers, management, customers, etc.
• Ensures compliance with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintains complete confidentiality of company business.
• Maintains communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.        
• Document credentialing decisions of the Dental Director.
• Act as subject matter expert to assist other departments with credentialing information.
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
• Maintain complete confidentiality of company business.
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.    

What Qualifications You Need

• Bachelor’s degree and 5 years of credentialing, health provider relations or related experience OR 9 years of credentialing, provider relations or healthcare administration related experience
• Ability to communicate effectively both orally and in writing.
• Customer service skills.
• Ability to respond to emails timely and effectively.
• Information research skills.
• Knowledge of dental provider credentialing and accreditation principles, policies, processes, procedures, and documentation.
• Working knowledge of clinical and/or hospital operations and procedures.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
• Ability to make administrative/procedural decisions and judgments.
• Demonstrated advanced working knowledge of Microsoft Word and Excel.
• Ability to learn new applications to function effectively
• Skill in establishing priorities with independent coordination of day-to-day aspects.
• Advanced skills in computerized spreadsheeting and database management.

Why Work with Chamberlain?
Chamberlain Advisors is a veteran-owned business that provides human capital solutions across a wide range of industries and engagement types. Chamberlain candidates benefit from our unique hiring and interviewing process which has been designed to increase the likelihood that they will be successful in their job searches. This is achieved through our 5-step recruitment process, ensuring a top-of-the-line candidate experience. Find out what makes us different; apply to Chamberlain today.

Equal Employment Opportunity
Chamberlain Advisors provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Chamberlain Advisors complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Chamberlain Advisors expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Chamberlain Advisors' employees to perform their job duties may result in discipline up to and including discharge.

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