Credentialing Specialist

Orthodontic Experts Management LLC•Des Plaines, IL

About The Position

The Credentialing Specialist will provide credentialing services to support the enrollment, maintenance, and compliance of provider credentials with various insurance payers, state licensing boards, and regulatory entities. All services shall be completed in accordance with company procedures and applicable industry and HIPAA-compliant standards.

Requirements

High school diploma or equivalent
1–3 years of administrative, clerical, dental, or healthcare office experience
Strong attention to detail, documentation accuracy, and data entry
Proficiency in Microsoft Office/Google Workspace; familiarity with EMR/CRM systems
Excellent professional written and verbal communication
Organized, punctual, dependable, and process-oriented

Responsibilities

Completing and submitting credentialing and re-credentialing applications to insurance payers and networks
Tracking and following up on application statuses with payers and other agencies
Verifying provider licensure, certifications, education, and professional history
Maintaining accurate and up-to-date provider records in internal systems
Managing provider rosters and payer portals
Communicating with internal management/providers and third-party payers to ensure credentialing deadlines are met
Responding to credentialing-related requests or issues from management or external parties
Documenting credentialing activities and communications thoroughly and accurately
Assisting in preparing reports, rosters, or audits related to credentialing and compliance
Escalating delays, denials, or compliance risks as needed