Credentialing Specialist

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

📋 Description

• Comply with NCQA standards.

• Review Provider Licensure Files to ensure adherence to NCQA guidelines.

• Generate Monthly Delegated Verification Files in line with NCQA requirements.

• Familiarity with Delegated Verification Websites (e.g., National Provider Data Base, etc.).

• Comprehension of Initial and Re-Credential Delegated files and their processing.

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

• Upload and refresh the system and/or software with updated documents.

• Request and secure any necessary Licensure renewals.

• Proficient in utilizing licensure portals.

• Experience with Clearinghouse and Manual Education Verifications.

• Experience in Manual Hospital Privileges Verifications.

• Experience in Board Certification Verifications via the appropriate portals.

• Strong understanding of the distinctions between similar credentials (e.g., Malpractice, Diplomas, etc.).

• Knowledge of the components of a Credentialing Committee.

• Coordinate, monitor, maintain, and process all internal re-credentialing according to NCQA guidelines.

• In-depth understanding of Attestation questions, actions, exclusions, and explanations.

• Ability to communicate effectively with providers, educators, and internal departments.

• Assist offices and internal departments in resolving credentialing issues.

• Capacity to multi-task effectively in a fast-paced environment.

• Undertake additional projects as assigned.

⛳️ Requirements

• High School Diploma is required.

• At least 2-3 years of experience in Healthcare Credentialing, preferably in Dental.

• Exceptional verbal and written communication skills.

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

• Proficient in Microsoft Office applications, including Word, Excel, Outlook, and Adobe.

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

• Designated workspace equipped with high-speed internet and access to a hotspot if necessary.

🏝️ Benefits

• Join a purpose-driven organization that is transforming dental care.

• Collaborate with a passionate and innovative team.

• Access to state-of-the-art technology and professional development resources.

• Competitive salary and benefits package.