Credentialing Specialist

hace 3 semanas

Ciudad de México Reach Digital A tiempo completo

Position Summary The Dental Insurance Credentialing Specialist is responsible for completing, submitting, and maintaining all credentialing and re-credentialing applications for dentists, group practices, and facilities with State Medicaid programs, Medicare, and PPO insurance carriers. This role ensures providers are properly enrolled, contracted, and compliant with state licensing boards and insurance networks to support timely reimbursement and uninterrupted patient care. Key Responsibilities Credentialing & Enrollment - Prepare, complete, and submit credentialing and re-credentialing applications for: • Illinois Medicaid (IMPACT) • Florida Medicaid • Medicare PECOS enrollment • Major PPO dental plans (Delta Dental, Aetna, Cigna, Humana, UnitedHealthcare, MetLife, BCBS, etc.)- Coordinate provider enrollment, reassignment of benefits, and group linkage for both states. - Track application progress and follow up until approval is confirmed. - Maintain accurate credentialing documentation including licenses, DEA certificates, insurance, and CE compliance. State Licensing Board Submissions - Prepare and submit necessary documentation to: • Illinois Department of Financial & Professional Regulation (IDFPR) • Florida Board of Dentistry - Ensure provider licenses and state requirements remain active and up to date. Insurance Network Management - Confirm effective dates, contracted fee schedules, and provider participation status. - Update internal systems with new insurance contracts and network changes. - Communicate credentialing status with practice leadership and billing teams. Compliance & Documentation - Maintain digital credentialing files including expiration tracking for licenses, CPR, DEA, liability insurance, etc. - Ensure compliance with federal, state, and payer requirements. - Provide timely updates and resolve discrepancies with insurance carriers and state agencies. Communication & Support - Serve as primary point of contact for payers, licensing boards, and providers regarding credentialing. - Communicate delays, missing items, or required provider actions. - Assist practices with credentialing audits or documentation requests. Qualifications Required: - Minimum 2 years of credentialing experience - Knowledge of Medicare PECOS and common PPO dental networks. - Excellent communication, organizational, and follow-up skills. - Ability to manage multiple providers and deadlines. Preferred: - Familiarity with dental practice management systems or credentialing software. Skills & Competencies - High attention to detail and accuracy - Strong administrative and documentation skills - Ability to navigate payer websites and state portals - Problem-solving and deadline management - Professional communication with providers and insurance reps - Confidentiality and compliance with HIPAA standards Physical & Work Requirements - Ability to work remotely with reliable internet access (if applicable)- Ability to handle repetitive administrative tasks with accuracy - Occasional travel to state licensing meetings or offices (if required)

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