Credentialing Assistant

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 carriers, including Medicaid. This role ensures compliance with state, federal, and company regulations while maintaining accuracy and timeliness in all submissions. The specialist will track application progress, communicate with insurance carriers and providers, and support internal stakeholders to ensure a seamless credentialing process.

Key Responsibilities

* Credentialing Applications:
Prepare, submit, and track initial credentialing and re-credentialing applications for dental providers with commercial and Medicaid insurance carriers.

* Medicaid Enrollment:
Manage Medicaid enrollment and revalidation processes across multiple states, ensuring strict adherence to state-specific requirements.

* Verification:
Verify provider licenses, certifications, education, DEA registration, malpractice coverage, and professional references in accordance with payer and regulatory standards.

* Documentation Maintenance:
Maintain complete and up-to-date provider files, ensuring all records meet payer and compliance standards.

* Regulatory Compliance:
Ensure all credentialing activities comply with HIPAA, federal and state regulations, and payer-specific requirements.

* Carrier Follow-Up:
Proactively follow up with insurance carriers and Medicaid representatives to expedite application approvals and resolve deficiencies.

* Provider & Field Communication:
Serve as the primary contact for providers and field offices regarding credentialing status, requirements, and timelines.

* Stakeholder Updates:
Provide regular status updates to internal leadership and operational teams.

* Database Management:
Maintain an accurate, organized, and secure credentialing database.

* Renewal Tracking:
Monitor and track expiration dates for licenses, certifications, and payer enrollments to prevent lapses in participation.

* Process Improvement:
Identify and implement process improvements to increase efficiency, reduce turnaround times, and maintain compliance.

* Policy Support:
Assist in developing and updating credentialing policies and procedures to ensure consistency and alignment with industry standards.

Required Qualifications

* Experience:

* Minimum 5+ years of dental or medical credentialing experience required.

* Extensive experience working with Medicaid enrollment and revalidation is required.

* Education:

High school diploma or equivalent required.

* Knowledge:

* Strong understanding of commercial insurance networks and Medicaid payer requirements.

* Knowledge of provider enrollment processes, CAQH, NPPES, and state Medicaid portals.

* Solid understanding of HIPAA and state/federal healthcare regulations.

* Technical

Skills:

* Proficient in Microsoft Office Suite (Word, Excel, Outlook).

* Experience with credentialing software and provider databases.

* Skills &

Competencies:

* Exceptional organizational and time-management skills.

* Strong attention to detail and accuracy.

* Excellent written and verbal communication skills.

* Ability to manage multiple deadlines in a fast-paced environment.

* Additional Knowledge:

* Understanding of dental terminology and procedures preferred.

Location Requirement

Candidates must reside in one of the following states:

Florida (FL), Georgia (GA), North Carolina (NC), South Carolina (SC), Mississippi (MS), Alabama (AL), Texas (TX), or Virginia (VA).

Working Conditions

* Remote/work-from-home position.

* Occasional overtime may be required to meet deadlines or manage high workloads.