Credentialing Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Organize, manage, and validate all facets of the assigned credentialing process for both General and Specialty Dentists.

• Ensure compliance with all legal and regulatory policies and procedures.

• Follow NCQA guidelines diligently.

• Conduct audits of provider licensure files to align with NCQA standards.

• Retrieve monthly delegated verification files in accordance with NCQA requirements.

• Prepare and present provider files for both internal and external audits.

• Upload and refresh systems/software with new documentation.

• Request and secure licensure renewals.

• Process both initial and re-credentialing delegated files efficiently.

• Coordinate, oversee, and manage internal re-credentialing in compliance with NCQA guidelines.

• Handle attestation questions, actions, exclusions, and explanations.

• Communicate effectively with providers, educators, and internal departments.

• Assist offices and internal teams with credentialing challenges.

• Engage in additional assigned projects as needed.

⛳️ Requirements

• A High School Diploma is required.

• A minimum of 2-3 years of experience in Healthcare Credentialing, preferably in Dental.

• Exceptional verbal and written communication abilities.

• Highly organized and detail-oriented with the capability to manage multiple tasks simultaneously.

• Proficiency in Microsoft Office applications, including Word, Excel, Outlook, and Adobe is required.

• Must be able to operate with minimal supervision and effectively prioritize work tasks.

• Experience in submitting Insurance/Payer Applications.

• A designated workspace with high-speed internet access, and the ability to utilize a hotspot if necessary.

• Familiarity with NCQA guidelines and the delegated credentialing process.

• Experience using licensure portals and credential verification websites.

• Knowledge in Clearinghouse / Manual Education Verifications.

• Experience in Manual Hospital Privileges Verifications.

• Experience in Board Certification Verifications through relevant portals.

🏝️ Benefits

• Competitive salary and benefits package.

• Access to state-of-the-art technology.

• Resources for professional development.

• Opportunities for remote work or telecommuting.