Job Description

Job Description

Job Description

Credentialing Specialist | Full Time | Remote

The Credentialing Specialist is responsible for coordinating and maintaining the credentialing, recredentialing, and payer enrollment processes for dental providers across all IDS-supported practices. This role ensures timely and accurate submissions to insurance carriers and regulatory bodies, maintaining compliance with each payor’s specific requirements. The Specialist partners closely with the Manager of Payor Strategies, Regional Operations, and Practice Leadership to support accurate billing, timely reimbursement, and efficient onboarding of providers.

Core Responsibilities

Credentialing & Enrollment:

• Prepare and submit complete, accurate provider credentialing and recredentialing applications to dental insurance carriers, Medicaid programs, and other payer networks. Maintain comprehensive records of credentialing documents, CAQH profiles, licenses, DEA, malpractice insurance, and related compliance materials.
• Monitor application status and follow up proactively with carriers to ensure timely processing.
• Manage payor enrollment for new practices and new providers, ensuring seamless participation and claim acceptance.
• Assist with National Provider Identifier (NPI) registration and updates as needed.

Maintenance & Compliance:

• Track expiration dates for licenses, DEA, malpractice coverage, and other required credentials; coordinate renewal reminders.
• Maintain an up-to-date database of provider credentialing status across all practices.
• Ensure compliance with state, federal, and payer-specific regulations governing credentialing and participation.
• Support audits, both internal and external, by providing required credentialing documentation and verification.

Collaboration & Communication:

• Serve as the liaison between the Payor Strategies team, providers, and dental practices to resolve credentialing or payor participation issues.
• Partner with the Revenue Cycle Management (RCM) and Insurance Verification teams to confirm payor setup accuracy.
• Communicate application status updates, carrier effective dates, and payor changes to practice and leadership stakeholders.
• Collaborate with the Manager of Payor Strategies to identify process improvements, streamline workflows, and maintain standardization across the IDS network.

Qualifications:

• Education: High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration, Business, or related field preferred.
• Experience: Minimum 2 years of experience in dental or medical credentialing, payor enrollment, or insurance contracting required.

Skills & Competencies:

• Strong attention to detail and organizational skills.
• Proficient in Microsoft Office Suite (Excel, Word, Outlook).
• Knowledge of CAQH, NPI Registry, and insurance credentialing systems.
• Ability to interpret carrier requirements and maintain regulatory compliance.
• Excellent written and verbal communication skills.
• Proven ability to manage multiple priorities and meet deadlines.

Performance Indicators:

• Accuracy and timeliness of credentialing submissions.
• Reduced turnaround time from submission to carrier effective date.
• Maintenance of current and compliant provider files.
• Positive feedback from practices and Payor Strategies leadership.
• Contribution to standardized credentialing processes across the network.

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