Credentialing Specialist

Orthodontic Experts Management LLC•Des Plaines, IL

2d•$21 - $22•Onsite

About The Position

The Credentialing Specialist provides credentialing services to support the enrollment, maintenance, and compliance of provider credentials with insurance payers, state licensing boards, and regulatory entities. Work must follow company procedures and applicable industry and HIPAA-compliant standards. The role is based in an on-site office environment and involves frequent interaction with clinical and administrative teams in a fast-paced, service-oriented setting.

Requirements

High school diploma or equivalent.
Exceptional attention to detail and strong administrative follow-through.
Proficiency with provider enrollment portals.
Ability to manage multiple priorities across several locations.
Discretion and professionalism when handling sensitive information.
Proven success navigating and resolving complex payer enrollment delays, administrative blocks, or claim rejections due to credentialing.

Nice To Haves

Associate or bachelor's degree.
Experience within a Dental Support Organization (DSO) or healthcare network; the posting also lists construction as a plus.
One to three years of healthcare credentialing or provider enrollment experience.
Certified Provider Credentialing Specialist (CPCS) certification.
Fluency in a second language, such as Spanish.

Responsibilities

Complete and submit credentialing and re-credentialing applications to insurance payers and networks.
Track and follow up on application statuses with payers and other regulatory agencies.
Verify provider licensure, certifications, education, and professional history.
Maintain accurate, current provider records and documentation in internal systems.
Manage provider rosters and update primary payer portals.
Document credentialing activities, timelines, and communications accurately and thoroughly.
Communicate with internal management, healthcare providers, and third-party payers to meet credentialing deadlines.
Respond promptly to credentialing-related requests or issues from management and external parties.
Escalate application delays, payer denials, and potential compliance risks to management as needed.
Assist with reports, provider rosters, and specialized credentialing and compliance audits.
Ensure handled workflows meet HIPAA privacy regulations and organizational standards.
Perform other duties as assigned.