Healthcare Credentialing & Enrollment 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

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.