Credentialing Specialist

Reach Digital; A distancia; MXN 200,000 - 400,000; Jornada completa

Descripción de la vacante

A leading digital health firm is seeking a Credentialing Specialist to manage the credentialing process for dental providers. This role includes preparing applications, maintaining compliance with state and federal requirements, and communicating effectively with providers and insurance networks. Candidates should possess at least 2 years of credentialing experience, excellent organizational skills, and the ability to handle multiple deadlines. Remote working options are available.

Formación

• Minimum 2 years of credentialing experience.
• Knowledge of Medicare PECOS and common PPO dental networks.
• Strong ability to manage multiple providers and deadlines.
• Excellent communication and organizational skills.

Responsabilidades

• Prepare and submit credentialing and re-credentialing applications.
• Maintain accurate credentialing documentation.
• Ensure compliance with state licensing and insurance requirements.
• Provide support and communication with practice leadership.

Conocimientos

Credentialing experience

Knowledge of Medicare PECOS

Excellent communication skills

Organizational skills

Follow-up skills

Attention to detail

Problem-solving skills

Descripción del empleo

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)