Credentialing Specialist

Great Expressions; Southfield (MI); Hybrid; USD 45,000 - 60,000; Full time

Job summary

Great Expressions is seeking a Credentialing Specialist to gather provider documentation for enrollment in contracted dental plans and to manage initial submissions with diligent follow-up.

You will verify data accuracy, maintain records, and support Medicaid enrollments and re-validations, while coordinating with payors and regional teams in a hybrid corporate office setting in Southfield, MI.

Qualifications

• Associates degree or equivalent credentialing experience.
• Prior experience with dental/health credentialing and provider enrollment.
• Proficiency in Microsoft Outlook and Excel.
• Excellent communication skills and customer focus; analytical and detail-oriented.

Responsibilities

• Collect provider documents for enrollment in dental plans.
• Submit initial enrollment applications and follow up on those applications.
• Verify the accuracy of all credentialing and enrollment information.
• Maintain practice management system with submission, follow-up, and effective dates.

Skills

Credentialing

Provider Enrollment

Attention to Detail

Communication

Education

Associates degree or equivalent credentialing experience

Tools

Microsoft Outlook

Excel

Job description

What you'll do...

The Credentialing Specialist's primary role is to collect the appropriate provider documentation to enroll the provider in all the dental plans with which Great Expressions is contracted and the provider is eligible with. This position will be responsible for submitting initial enrollment applications, and all associated follow up on those applications. The Credentialing Specialist will also be responsible for verifying the accuracy of all submitted credentialing and enrollment information.

This position is located at our corporate office in Southfield, MI and has a hybrid schedule of Monday, Tuesday, Thursday in office and Wednesday/Friday remote.

What you'll bring to the team...

• Responsible for preparing enrollment applications for new and established providers within a region
• Ensures that applications are completed accurately, comprehensively and are sent out in a timely manner
• Organizes credentialing-related files and verifies that required documents for applications are collected from providers
• Validates that information on required documents match enrollment applications and ensure there are no discrepancies
• Recognizes, investigates, and validates discrepancies in information obtained from providers
• Submits enrollment applications, stores record of submissions and provides payors with additional information to if requested
• Follows up with payors proactively on pending applications in advance of a provider's start date
• Collects effective date from payors and stores confirmation of enrollment
• Maintains practice management system with accurate information - submission dates, follow-up dates and effective dates as well other required data
• Responsible for Medicaid enrollment applications and re-validations prior to expiration date
• Responds to directory validation and other such requests from payors
• Proactively provides updates to regional team on providers and statuses on enrollment with payors and responds to any ad-hoc inquiries
• Demonstrates the ability to effectively prioritize tasks and set short/long term goals to achieve them
• Expresses thought clearly, concisely, and effectively both verbally and in writing. Ensures a free flow of information and communication upward, downward, and across the organization by actively listening
• Compiles, evaluates, and presents the provider specific data collected for review by one or more decision making bodies
• Assist with all re-credentialing request
• Sorts and handles mail
• Other tasks as requested by direct Manager

What we require you have...

• Associates degree or equivalent credentialing experience

• Prior experience with dental/health credentialing & provider enrollment
• CPCS or CPMSM certification a plus
• Proficiency in Microsoft Outlook and Excel
• Excellent Communication skills and customer focusAnalytical and problem solving skills with a passion for detail & accuracy
• Reliability and flexibility with time committed to the position
• Excellent organizational and time management ability

About GEDC...

Since 1982, Great Expressions has been at the forefront of dental innovation, setting the standard for exceptional care and unforgettable patient experiences. Now, we're entering a new era of transformation, and we want you to be a part of it. Our recently appointed leadership team brings over a century of collective dental expertise and is backed by dynamic investment support to pave the way for groundbreaking changes. We're channeling our resources and energy into revolutionizing our technology platform, expanding service offerings, and creating a personalized patient experience that goes beyond the expected. At Great Expressions, we're not just transforming dentistry; we're investing in the growth and development of our team. Join us and be a part of a career that blends innovation and professionalism, where your contribution shapes the future of dental excellence.