Credentialing Specialist

Billing SpecialistBilling SpecialistFull TimeRemoteMid LevelTeam 51-200

Location

United States

Posted

43 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Credentialing Specialist

Andros

Mission The mission of this role is to help coordinate and manage our Facilities and Provider credentialing within our Network Management team, its processes, and services. Support a seamless client experience and deliver on all client SLAs - at all times. Provide transparency, communication, and documentation of credentialing processes, workflows, and other artifacts that can be shared internally and with clients. Adhere to, support, and drive quality measures for the overall credentialing operation, both within Andros and client-facing operations, ensuring excellence in service delivery, program health, and compliance adherence. Outcomes - Credentialing Program Execution: - - Verify and maintain licensing, credentials, and insurance records and other PSVs as required - Conduct research on updated state and federal regulations and policies - Help develop internal credentialing processes - Perform duties using our established work systems and methods; maintain our structured workflows to support standardized processes and strive to continuously improve them - Manage and assist in the timely resolution of both internal and external requests - Be responsible for data entry and maintain provider information in Andros’ database - Be responsible for completing provider and facility initial and re-credentialing applications - Quality Assurance of Credentialing: - - Collaborate with immediate and internal teams (Credentialing Manager and team) to build quality metrics: - - Eliminate errors in our work and client deliverables - Reduce waste and re-work - Help build and support a metrics-driven, structured workflow to standardize processes across all clients, while accommodating unique client specifications - Process Improvement & Development: - - Support the process for driving both incremental improvements and the next generation of Credentialing - Continuously build on subject matter knowledge, including role-specific and leadership/facilitation competencies - Increase domain expertise by ensuring all Credentialing activities and artifacts are documented, remain current, and trained to teams appropriately Role-Specific Competencies - Ownership - You own everything in your domain and take responsibility to get results without excuses or blame. You earn trust through being reliable - Communication - You are concise, articulate, and timely in all communications. You listen actively, understand questions (and clarify when unclear), and speak up even when it might be uncomfortable - Problem Solving - You are able to figure out solutions that others may have missed. You are able to work autonomously and as a team player when it comes to tackling issues that seem impossible. You never settle for “good enough”, rather, you operate with a “how can I/we be better?” mentality - Attention to Detail - You mind the details so nothing slips through the cracks - Flexibility/Adaptability - You adjust quickly to changing priorities and conditions. You cope effectively with complexity and change - Follow-through on Commitments - You live up to verbal and written agreements without fail - High Standards - You lead by example and expect personal performance and team performance to be nothing short of the best Qualifications - Familiar with provider credentialing and recredentialing requirements - Strong computer and software skills - Excellent interpersonal skills, including excellent verbal and written communication skills - Ability to demonstrate a high degree of trust and confidentiality - Ability to work independently and assume assigned responsibilities - Skilled in efficiency, organization, time management, and prioritization - Ability to be flexible and function well in a fast-paced environment - Ability to deal with problems involving several concrete variables in standardized situations - Ability to handle confidential information - Minimum 3+ years of provider healthcare credentialing experience (does not include provider enrollment) - Experience with Microsoft Excel, Jira, Google Sheets, and Tableau is a plus Hourly rate of $24.00

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Banner Health logo

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Smile Brands logo

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Smile Brands works with general and multispecialty dental groups in the United States to provide support services, and through its work, it supports over 7,500

Overview At Smile Brands, we’re more than a dental support organization — we’re a community focused on delivering Smiles for Everyone®. With a network of 600+ practices across 30 states, we empower our teams to thrive, grow, and make a real impact. If you're looking for a place where your work truly matters, you’ve found it. We are seeking a Credentialing Specialist to join our Payer Solutions Group. In this role, you’ll play a vital part in supporting our dental operations by managing provider credentialing, plan enrollment, and contract tracking to ensure compliance and seamless onboarding. An ideal candidate is detail-oriented, highly organized, and thrives in a fast-paced environment while juggling multiple priorities. Schedule (days/hours) Monday - Friday 8am - 5pm Responsibilities - Manage and track provider credentialing, re-credentialing and dental plan enrollment processes. - Maintain accurate records in credentialing databases and update provider/facility information. - Support the delegated credentialing process and roster submission to payers. - Communicate regularly with dental plans, internal teams, and dental offices to resolve issues and ensure timely approvals. - Monitor license and credential expirations, ensuring timely renewals and no service gaps. - Prepare, review, and process applications, contracts, W-9s, and related documentation. - Coordinate provider terminations and changes, including plan notifications and updates. - Support audits, reporting, and re-credentialing cycles. - Proactively identify and escalate issues or process gaps. Qualifications - 2+ years of experience in dental, medical, or insurance credentialing/contracting. - Strong attention to detail and accuracy in high-volume data entry. - Clear written and verbal communication skills. - Ability to manage multiple tasks and meet deadlines in a fast-paced environment. - Proficient in Microsoft Excel, Word, Outlook, and general internet research. Compensation $20 - $25/hr About Us Benefits are determined by employment status/hours worked and include paid time off (“PTO”), health, dental, vision, health savings account, telemedicine, flexible spending accounts, life insurance, disability insurance, employee discount programs, pet insurance, and a 401k plan. Smile Brands supports over 650 affiliated dental practices across 28 states all focused on a single mission of delivering Smiles For Everyone!® Smiles for patients, providers, employees, and community partners. Everyone. Our growing portfolio of affiliated dental brands and practice models range from large regional brands to uniquely branded local practices. This role is associated with the affiliated dental office listed at the top of the job posting on our career site. Smile Brands Inc. and all Affiliates are Equal Opportunity Employers. We celebrate diversity and are committed to providing an inclusive workplace for all employees. We are proud to be an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, creed, gender (including gender identity and gender expression), religion, marital status, registered domestic partner status, age, national origin, ancestry, physical or mental disability, sex (including pregnancy, childbirth, breastfeeding or related medical condition), protected hair style and texture (The CROWN Act), genetic information, sexual orientation, military and veteran status, or any other consideration made unlawful by federal, state, or local laws. If you would like to request an accommodation due to a disability, please contact us at careers@smilebrands.com

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