Credentialing Specialist

Sage Dental; Boca Raton, Northern (FL, KY); Hybrid; USD 52,000 - 76,000; Full time

Job summary

Sage Dental Management seeks a Delegated Credentialing Specialist (Remote) to organize, maintain and verify delegated credentialing for General and Specialty Dentists, ensuring compliance with NCQA guidelines and regulatory policies.

The role requires attention to detail, strong communication with providers and internal teams, experience with licensure portals, and ability to multi-task in a fast-paced environment; prior credentialing experience in healthcare/dental is preferred.

Qualifications

• High School Diploma required.
• Minimum 2-3 years’ experience in Healthcare Credentialing, Dental preferred.
• Excellent verbal and written communication skills.
• Well organized and detail-oriented with the ability to multi-task.
• Proficiency with Microsoft Office products, including Word, Excel, Outlook, and Adobe required.
• Must be able to function with minimal supervision and prioritize tasks.
• Insurance/Payer Application submission experience.

Responsibilities

• Adhere to NCQA guidelines.
• Audit Provider Licensure Files to NCQA guidelines.
• Pull Monthly Delegated Verification Files in accordance with NCQA.
• Knowledge of Delegated Verification Websites (ie. National Provider Data Base, etc.)
• Understanding of Initial and Re-Credential Delegated files / processing.
• Prepare and Present provider files for internal and external auditing.
• Upload and update the system and / or software with new documents.
• Request & Obtain any Licensure renewals.
• Must be able to utilize the licensure portals.
• Experience in Clearinghouse / Manual Education Verifications.
• Experience in Manual Hospital Privileges Verifications.
• Experience in Board Certification Verifications through the appropriate portals.
• Strong understanding of the differences between similar credentials (ie. Malpractice, Diplomas, etc.)
• Knowledge of what a Credentialing Committee consists of.
• Coordinate, monitor, maintain and process all internal re-credentialing to NCQA guidelines.
• Heavy Understanding of Attestation questions, actions, exclusions and explanations.
• Ability to speak effectively with providers, educators and internal departments.
• Assist offices and internal departments with credentialing issues.
• Ability to multi-task in a fast-paced environment.
• Work other projects as assigned.

Skills

Credentialing

NCQA guidelines

Communication

Microsoft Office

Organization

Education

High School Diploma

Tools

Licensure portals

Clearinghouse systems

Job description

Sage Dental Management is a leading, rapidly growing Dental Service Organization (DSO) committed to innovation, excellence, and patient-centered care.

Overview

Sage is looking for a Delegated Credentialing Specialist (Remote) to join our team! The Delegated Credentialing Specialist is responsible for organizing, maintaining, and verifying all aspects of the delegated credentialing process for General and Specialty Dentists. In all activities, they must comply with all legal and regulatory policies and procedures.

Responsibilities

• Adhere to NCQA guidelines.
• Audit Provider Licensure Files to NCQA guidelines.
• Pull Monthly Delegated Verification Files in accordance with NCQA.
• Knowledge of Delegated Verification Websites (ie. National Provider Data Base, etc.)
• Understanding of Initial and Re-Credential Delegated files / processing.
• Prepare and Present provider files for internal and external auditing.
• Upload and update the system and / or software with new documents.
• Request & Obtain any Licensure renewals.
• Must be able to utilize the licensure portals.
• Experience in Clearinghouse / Manual Education Verifications.
• Experience in Manual Hospital Privileges Verifications.
• Experience in Board Certification Verifications through the appropriate portals.
• Strong understanding of the differences between similar credentials (ie. Malpractice, Diplomas, etc.)
• Knowledge of what a Credentialing Committee consists of.
• Coordinate, monitor, maintain and process all internal re-credentialing to NCQA guidelines.
• Heavy Understanding of Attestation questions, actions, exclusions and explanations.
• Ability to speak effectively with providers, educators and internal departments.
• Assist offices and internal departments with credentialing issues.
• Ability to multi-task in a fast-paced environment.
• Work other projects as assigned.

Qualifications

• High School Diploma required.
• Minimum 2-3 years’ experience in Healthcare Credentialing, Dental preferred.
• Excellent verbal and written communication skills.
• Well organized and detail-oriented with the ability to multi-task.
• Proficiency with Microsoft Office products, including Word,Excel,Outlook, and Adobe required.
• Must be able to function with minimal supervision and be able to prioritize all work tasks.
• Insurance/Payer Application submission experience
• Designated workspace with high-speed internet and access to hot spot if needed.

What Sage Offers

Be part of a purpose-driven organization transforming dental care. Collaborate with a passionate, innovative team. Access to cutting-edge technology and professional development resources. Competitive compensation and benefits