Remote Payor Audit & Credentialing Specialist

Towncare Dental Partnership; Town of Florida (NY); On-site; USD 100,000 - 150,000; Full time

Job summary

Towncare Dental Partnership is seeking a Specialist – Payor Audit & Provider Enrollment to lead audits, respond to payor inquiries, and oversee enrollment data integrity across DentalXchange and connected systems.

You will interpret contracts, design risk-based response strategies, and mentor credentialing staff while partnering with Compliance, Revenue Cycle, and practice operations to sustain audit readiness and accurate enrollment records.

Qualifications

• HS diploma or equivalent; bachelor's degree preferred.
• 6+ years in dental/medical credentialing or healthcare revenue cycle with program ownership.
• Experience interpreting payor contracts and NCQA/URAC-aligned standards; multi-site experience preferred.
• CPCS/CPMSM or comparable credentialing/compliance certification preferred.

Responsibilities

• Lead payor audits and delegated credentialing activities; coordinate with Credentialing Manager.
• Design audit intake, risk-tiering, and tracking framework; assess scope and exposure.
• Draft formal responses to payors; coordinate with Legal, Clinical, or Compliance when needed.
• Monitor audit outcomes and translate findings into provider education and process changes.
• Maintain enrollment data governance for DentalXchange and related systems.

Skills

Analytical thinking

Risk judgment

Written communication

Verbal communication

Technical systems proficiency

Process ownership

Mentorship

Education

Bachelor's degree in healthcare administration or related field

Tools

DentalXchange

CDT coding

EDI/ERA systems

Job description

Towncare Dental Partnership is seeking a Specialist – Payor Audit & Provider Enrollment to lead audits, respond to payor inquiries, and oversee enrollment data integrity across DentalXchange and connected systems.

You will interpret contracts, design risk-based response strategies, and mentor credentialing staff while partnering with Compliance, Revenue Cycle, and practice operations to sustain audit readiness and accurate enrollment records.