Payor Audit & Enrollment Specialist

Dental One As; Sarasota, Northern (FL, KY); Hybrid; USD 55,000 - 85,000; Full time

Benefits offered by this job

Medical insurance

Dental services

Life insurance

Vision insurance

Long-term disability

Flexible Spending Account

401K

EAP program

Supplemental insurance

Job summary

Dental One As in the United States, Florida, specializing in payor audits and provider enrollment, seeks a Specialist to ensure data integrity and compliance across enrollment and billing systems.

You will manage payor-initiated audits from intake through final responses, interpret contracts and regulatory requirements, and advise Credentialing and Revenue Cycle leadership while mentoring staff.

Qualifications

• Experience interpreting payor contracts and delegation agreements.
• Understanding regulatory requirements for credentialing and enrollment.
• Ability to assess compliance and revenue risk and escalate when needed.

Responsibilities

• Serve as subject-matter expert for payor audits from intake through resolution.
• Oversee delegated credentialing audits and ensure readiness against standards.
• Govern provider enrollment and billing data acrossDentalXchange and connected systems.

Job description

The Specialist – Payor Audit & Provider Enrollment serves as the organization’s subject-matter expert for payor audit
response, delegated credentialing oversight, and provider enrollment data integrity. This role manages payor-initiated audits
from intake through resolution, determining response strategy and authoring formal responses on behalf of the organization;
leads delegated credentialing audits and maintains continuous audit readiness against payor and accreditation standards;
and governs provider enrollment and billing data within DentalXchange and connected systems. Working under general
direction, the Specialist interprets payor contracts, delegation agreements, and regulatory requirements, exercises
independent judgment in assessing and escalating compliance and revenue risk, and develops the policies, controls, and
reporting that govern these functions. The position advises Credentialing, Compliance, and Revenue Cycle leadership,
partners across practice operations and billing, and provides technical guidance and mentorship to credentialing and
enrollment staff.

Additional benefits

• Medical insurance
• Dental services
• Life insurance
• Vision insurance
• Long term disability
• Section 125 - Flexible Spending Account
• 401K
• EAP program
• DCA voluntary supplemental insurance products