Dental Provider Network Account Executive

Enlightened, Inc.; Washington (District of Columbia); Hybrid; USD 75,000 - 95,000; Full time

Benefits offered by this job

401(k) plan

Paid holidays

Paid vacation

Training reimbursement

HSA

FSA

Medical/Dental/Vision insurance

Job summary

Enlightened, Inc. in Washington, DC is seeking a Dental Provider Network Account Executive to develop and maintain strong relationships with participating dental providers and support credentialing, enrollment, and contract administration.

You will coordinate provider data management across multiple systems, ensure regulatory compliance, and collaborate with internal teams and external vendors to maintain network integrity and timely claims processing.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field, or an equivalent combination of education and experience.
• Three (3) or more years of experience in provider network management, provider relations, credentialing, provider enrollment, contracting, or healthcare operations.
• Experience supporting provider credentialing and enrollment activities.
• Working knowledge of managed care, Medicaid, Medicare, or commercial health plans.
• Strong organizational and time management skills with the ability to manage multiple priorities.
• Excellent verbal and written communication skills.
• Strong customer service and relationship management skills.
• Proficiency with Microsoft Office, including Excel, Word, and Outlook.

Responsibilities

• Manage the end-to-end provider credentialing and recredentialing process.
• Coordinate new provider enrollment from application through approval.
• Partner with delegated credentialing teams to ensure provider files are complete and regulatory requirements are met.
• Follow up with providers to obtain missing documentation and resolve credentialing deficiencies.
• Prepare provider contracts and coordinate execution with internal leadership.
• Maintain accurate provider records within LIFT and other provider management systems.
• Coordinate provider site visits required for credentialing and recredentialing.
• Support provider contracting activities, including new provider onboarding and ongoing provider maintenance.
• Manage provider additions, terminations, demographic updates, practice location changes, and provider profile maintenance.
• Maintain accurate provider information within Skygen to support claims processing and network operations.
• Coordinate provider site visits with American Dental Systems.
• Investigate and resolve provider claims and reimbursement issues.
• Serve as the primary operational contact for participating dental providers.
• Build and maintain strong relationships with Federally Qualified Health Centers (FQHCs), private dental practices, and group dental practices.
• Monitor Medicaid Identification Numbers (MAIDs) for participating providers and provider groups.
• Ensure provider records remain compliant with organizational, contractual, and regulatory requirements.
• Identify opportunities to improve operational processes and workflow efficiencies.
• Collaborate with internal departments to support provider network initiatives.
• Participate in weekly, biweekly, and monthly operational meetings, as well as cross-functional projects.

Skills

Organizational skills

Communication skills

Customer service

Relationship management

Time management

Attention to detail

Education

Bachelor's degree in Healthcare Administration or related field

Tools

Excel

Word

Outlook

Skygen

LIFT

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Professional Enlightened HQ, Washington, DC, US

3 days ago Requisition ID: 1235

Salary Range: $75,000.00 To $95,000.00 Annually

Company Overview

As one of the Washington metropolitan area's fastest-growing IT companies, Enlightened is always looking for creative, passionate, and responsible employees. We recognize that our intelligent and dedicated employees are our greatest asset, and we are continually expanding our talented and diverse team. If innovation, integrity, and a commitment to delivering exceptional results are key components of your success, we invite you to join Enlightened.

Work Arrangement

This is a hybrid position based in our Washington, DC office, conveniently located within walking distance of two Metro stations. Associates work four (4) days in the office and one (1) day remotely each week.

Position Summary

The Dental Provider Network Account Executive is responsible for developing and maintaining strong relationships with participating dental providers while supporting the day-to-day operations of the provider network. This position serves as the primary liaison between the health plan and its contracted dental providers, ensuring providers are successfully credentialed, contracted, enrolled, and maintained within the network.

The Dental Provider Network Account Executive partners with internal departments, delegated credentialing teams, providers, and external vendors to support provider onboarding, credentialing, contract administration, provider data management, operational issue resolution, and ongoing provider satisfaction. This role also ensures provider information is maintained accurately across multiple systems to support network integrity and timely claims processing.

Responsibilities

• Manage the end-to-end provider credentialing and recredentialing process.
• Coordinate new provider enrollment from application through approval.
• Partner with delegated credentialing teams to ensure provider files are complete and regulatory requirements are met.
• Follow up with providers to obtain missing documentation and resolve credentialing deficiencies.
• Prepare provider contracts and coordinate execution with internal leadership.
• Maintain accurate provider records within LIFT and other provider management systems.
• Coordinate provider site visits required for credentialing and recredentialing.
• Support provider contracting activities, including new provider onboarding and ongoing provider maintenance.
• Manage provider additions, terminations, demographic updates, practice location changes, and provider profile maintenance.
• Maintain accurate provider information within Skygen to support claims processing and network operations.
• Coordinate provider site visits with American Dental Systems.
• Investigate and resolve provider claims and reimbursement issues.
• Serve as the primary operational contact for participating dental providers.
• Build and maintain strong relationships with Federally Qualified Health Centers (FQHCs), private dental practices, and group dental practices.
• Monitor Medicaid Identification Numbers (MAIDs) for participating providers and provider groups.
• Ensure provider records remain compliant with organizational, contractual, and regulatory requirements.
• Identify opportunities to improve operational processes and workflow efficiencies.
• Collaborate with internal departments to support provider network initiatives.
• Participate in weekly, biweekly, and monthly operational meetings, as well as cross-functional projects.

Qualifications

Required

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field, or an equivalent combination of education and experience.
• Three (3) or more years of experience in provider network management, provider relations, credentialing, provider enrollment, contracting, or healthcare operations.
• Experience supporting provider credentialing and enrollment activities.
• Working knowledge of managed care, Medicaid, Medicare, or commercial health plans.
• Strong organizational and time management skills with the ability to manage multiple priorities.
• Excellent verbal and written communication skills.
• Strong customer service and relationship management skills.
• Proficiency with Microsoft Office, including Excel, Word, and Outlook.

Preferred

• Experience working with Skygen, LIFT, or similar provider management systems.
• Experience with delegated credentialing.
• Knowledge of provider contracting and provider lifecycle management.
• Experience working with Federally Qualified Health Centers (FQHCs).
• Knowledge of Medicaid provider enrollment and compliance requirements.

Preferred Knowledge & Skills

• Provider Network Management
• Provider Relations
• Provider Credentialing
• Provider Contracting
• Managed Care Operations
• Medicaid
• Provider Data Management
• Regulatory Compliance
• Cross-Functional Collaboration
• Relationship Management
• Process Improvement
• Attention to Detail
• Medical, Dental, and Vision Insurance
• Health Savings Account (HSA)
• Flexible Spending Account (FSA)
• 401(k) Retirement Plan
• Paid Holidays
• Paid Vacation
• Professional Training and Development Reimbursement

Equal Opportunity Employer

Enlightened is proud to be an Equal Opportunity Employer. We are committed to creating an inclusive workplace and consider all qualified applicants for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.