Dental Credentialing Specialist

Highmark Health; Pennsylvania; On-site; USD 29,000 - 41,000; Full time

Job summary

Highmark Inc. in Pennsylvania seeks a credentialing professional to process provider applications, maintain the provider database, and coordinate credentialing verifications.

You will contact providers by phone and mail, review enrollment information, and ensure data accuracy within the credentialing system. The role emphasizes compliance with HIPAA and URAC standards, collaboration with internal teams, and supporting audits and reports.

Qualifications

• Minimum High School Diploma or GED with 3-5 years of related, progressive experience.
• Experience in Provider Data Management, Customer Services or Claims.
• Microsoft Office experience (Word, Excel, PowerPoint, etc.)
• Familiarity with credentialing processes and the URAC standards.
• Experience in the use of ULTRA and Dental Provider File systems.
• Knowledge, Skills and Abilities include clear written and verbal communication.

Responsibilities

• Credentials and re-credential providers.
• Contact providers or representatives by telephone or in writing to obtain additional information while processing enrollment applications.
• Screen incoming applications and paperwork for completeness and accuracy and send necessary paperwork to credentialing vendor.
• Perform credentialing verifications and load provider to appropriate networks and credentialing information to the provider database.
• Manage credentialing inventory, reports and projects to ensure timeliness.
• Train credentialing team in systems, software, databases, processes and procedures as applicable.
• Create and distribute monthly reports and handle complex credentialing issues.
• Support audits, business partners, internal departments and external clients.
• Represent department as Subject Matter Expert.
• Pull and research necessary documentation for audits.
• Support updates necessitated by partners and clients.
• Provide customer oversight for unique requirements and timelines to ensure compliance.

Skills

Provider data mgmt

Customer service

Claims processing

Microsoft Office

Credentialing

URAC standards

ULTRA system

Dental Provider File

Education

High School Diploma or GED

Tools

ULTRA

Dental Provider File

Job description

Highmark Inc. in Pennsylvania seeks a credentialing professional to process provider applications, maintain the provider database, and coordinate credentialing verifications.

You will contact providers by phone and mail, review enrollment information, and ensure data accuracy within the credentialing system. The role emphasizes compliance with HIPAA and URAC standards, collaboration with internal teams, and supporting audits and reports.