Credentialing & Payer Operations Specialist

Remote Jobs; American Fork (UT); Vor Ort; USD 25.000 - 28.000; Vollzeit

Zusammenfassung

Platinum Dental Services seeks a Credentialing Specialist to manage provider credentialing, enrollment, and fee schedule maintenance across multiple locations. This in-person role supports accurate payer participation and timely credentialing updates for our growing network.

The ideal candidate will be detail-oriented with strong analytical skills, capable of handling large data sets, and collaborating with internal teams and external payers to resolve issues, while ensuring compliance and data

Qualifikationen

• Strong organizational skills with the ability to manage multiple projects, deadlines, and priorities.
• Excellent attention to detail and commitment to data accuracy.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Excel or Google Sheets, including working with spreadsheets, formulas, and data comparisons.
• Strong research, analytical, and problem-solving abilities.
• Ability to work independently while collaborating with a team.
• Willingness to learn complex insurance processes, payer requirements, and reimbursement structures.
• Ability to maintain confidential information and follow applicable privacy and compliance requirements.

Aufgaben

• Coordinate end-to-end credentialing and recredentialing for dental providers across multiple states and locations.
• Prepare, review, submit, and track credentialing applications, provider enrollments, and location additions.
• Maintain accurate provider information, including licenses, DEA registrations, malpractice coverage, CAQH profiles, and other documentation.
• Monitor application statuses, follow up with insurers, and escalate delays or discrepancies as necessary.
• Coordinate provider onboarding, location changes, and separations to ensure timely payer participation updates.
• Verify provider participation, network affiliations, and effective dates to support accurate billing.

Kenntnisse

Organizational skills

Attention to detail

Communication skills

Excel/Sheets proficiency

Research/analytical abilities

Independent working

Privacy/compliance

Tools

Microsoft Excel

Google Sheets

Jobbeschreibung

Platinum Dental Services seeks a Credentialing Specialist to manage provider credentialing, enrollment, and fee schedule maintenance across multiple locations. This in-person role supports accurate payer participation and timely credentialing updates for our growing network.

The ideal candidate will be detail-oriented with strong analytical skills, capable of handling large data sets, and collaborating with internal teams and external payers to resolve issues, while ensuring compliance and data