Credentialing Specialist

D4C Dental Brands, Inc.; Atlanta (GA); On-site; USD 55,000 - 70,000; Full time

Benefits offered by this job

PTO

Holidays

Medical/Dental/Vision benefits

HSA/FSAs

401K

Disability Insurance

Life Insurance

Community Service

Job summary

D4C Dental Brands is seeking a Credentialing Specialist to lead and coordinate credentialing and re-credentialing for practitioners across our network of dental practices in Atlanta. You will liaise with health plans, hospitals, and care facilities to ensure enrollment, malpractice coverage, and timely approvals.

The role requires attention to detail, problem solving, and knowledge of CAQH applications, NPI updates, and licensure tracking.

Qualifications

• High school diploma; Bachelor’s degree preferred.
• 2-3 years experience in Managed Care credentialing and Medicaid enrollment.
• Experience with integrating dental practices and acquisitions.
• NAMMS Certifications is a plus.

Responsibilities

• Liaise between the practitioners, health plans, hospitals, patient care facilities and all related entities regarding credentialing, malpractice coverage, and practitioner enrollment.
• Manage credentialing and re-credentialing processes along with completing applications for respective Commercial and Medicaid dental plans; contacting doctors for additional documentation if required; monitoring applications for timely approval and follow-up as needed.
• Management of CAQH applications including completion and updates. Maintains provider information in online credentialing databases and systems.
• Responsible for all necessary updates including, but not limited to address changes, NPI updates, etc.
• Ensures facility addresses, provider information is current with health plans, agencies and other entities.
• Coordinate, compile, and prepare reports pertaining to doctors as requested. Preparation of correspondence associated with the credentialing process.
• Maintains knowledge of current health plans and agencies requirements for credentialing doctors.
• Tracks license and certification expirations for all practitioners to ensure timely renewals. Follow-up with practitioners regarding expiring documents to ensure compliance.
• Performs other duties as assigned.

Education

High school diploma

Bachelor’s degree preferred

2-3 years experience in Managed Care credentialing and Medicaid enrollment

Experience with integrating dental practices and acquisitions

NAMMS Certifications

Job description

• Location 2970 Brandywine Rd,Suite 200,Atlanta, GA, 30341,United States
• Employee Type Non-Exempt

Description

The Credentialing Specialist will be responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.

• Liaise between the practitioners, health plans, hospitals, patient care facilities and all related entities regarding credentialing, malpractice coverage, and practitioner enrollment.
• Manage credentialing and re-credentialing processes along with completing applications for respective Commercial and Medicaid dental plans; contacting doctors for additional documentation if required; monitoring applications for timely approval and follow-up as needed.
• Management of CAQH applications including completion and updates. Maintains provider information in online credentialing databases and systems.
• Responsible for all necessary updates including, but not limited to address changes, NPI updates, etc.
• Ensures facility addresses, provider information is current with health plans, agencies and other entities.
• Coordinate, compile, and prepare reports pertaining to doctors as requested. Preparation of correspondence associated with the credentialing process.
• Maintains knowledge of current health plans and agencies requirements for credentialing doctors.
• Tracks license and certification expirations for all practitioners to ensure timely renewals. Follow-up with practitioners regarding expiring documents to ensure compliance.
• Performs other duties as assigned.

Education and Experience:

• High school diploma; Bachelor’s degree preferred.
• 2-3 years experience in Managed Care credentialing and Medicaid enrollment.
• Experience with integrating dental practices and acquisitions.
• NAMMS Certifications is a plus.

We take care of our valued employees by offering:

• Paid Time Off
• Paid Holidays
• Medical, Dental and Vision benefits
• Health Savings Account, Flex Spending
• 401K
• Short and Long Term Disability Insurance
• Life Insurance
• Opportunities for Community Service

About D4C Dental Brands

Work that Matters

At D4C Dental Brands, team members are positioned to make a difference in the lives of patients. As the leading and fastest growing support organization for specialty dental practices, we are able to enhance and advance the overall patient experience. Our success comes from our focus on supporting high quality patient care and our shared vision of “Raising the Standard in children’s oral health." If you’re ready to make a difference in the lives of children – and to positively impact the healthcare system at large – there’s no better place to make this happen. We believe that when committed teams come together with dedicated expert dentists for the purpose of helping children achieve a lifetime of great oral health, the results are tremendous. This shared commitment is the foundation to everything we do.