Delegated Credentialing Specialist

MB2 Dental•Carrollton, TX

1d•Onsite

About The Position

MB2 Dental, a Dental Partnership Organization (DPO) founded in 2007, is seeking a Delegated Credentialing Specialist. The Credentialing Department is responsible for verifying the qualifications of dental providers and ensuring their enrollment in insurance networks and government programs. This involves managing the entire credentialing lifecycle, collaborating with insurance organizations and internal teams to maintain accurate provider data, resolve discrepancies, and keep provider profiles updated. The department also focuses on building relationships with dental practices, insurance providers, and internal stakeholders, while driving process improvements for seamless collaboration and increased productivity.

Requirements

Minimum of 2 years of healthcare credentialing experience
Working knowledge of credentialing principles, primary source verification, provider lifecycle management, and compliance documentation
Strong organizational skills with the ability to prioritize work, meet deadlines, and maintain accuracy in a high-volume environment
Strong written and verbal communication skills with the ability to work effectively with internal teams, providers, practices, and payer contacts
Ability to handle confidential information with professionalism and sound judgment

Nice To Haves

Experience using Credential Stream or a comparable credentialing platform preferred

Responsibilities

Manage the end-to-end credentialing lifecycle for providers participating with delegated dental payer networks.
Ensure providers are credentialed in accordance with delegated agreements, accreditation standards, payer requirements, and MB2 Dental policies.
Support timely provider onboarding and uninterrupted revenue generation.
Coordinate credentialing and recredentialing for dentists and specialists participating in delegated payer networks.
Review provider applications and supporting documentation for completeness, accuracy, timeliness, and compliance with payer and internal requirements.
Complete primary source verification for licenses, DEA registrations, controlled substance permits, education and training, work history, malpractice history, sanctions, exclusions, and other required elements.
Prepare credentialing files for clean-file approval, special review, and Credentialing Committee decision-making.
Identify, document, and escalate red-flag findings, including licensure issues, sanctions, exclusions, malpractice history, NPDB findings, Medicare or Medicaid concerns, quality issues, and other adverse information.
Maintain accurate provider records in the credentialing platform, including demographics, verification results, status updates, expirables, and committee outcomes.
Monitor and update provider expirables, including professional licenses, DEA registrations, state-controlled substance registrations, malpractice coverage, certifications, and required attestations.
Support ongoing monitoring, including state board actions, OIG and SAM exclusions, Medicare opt-out and preclusion list reviews, complaints, quality concerns, and other delegated monitoring requirements.
Support delegation audits, including pre-audit file reviews, documentation requests, sample file preparation, audit response tracking, and corrective action follow-up.
Protect the confidentiality and integrity of credentialing records by following access controls, documentation standards, modification requirements, and record retention expectations.