Dental Network Specialist

BizTek People, Inc. | APA International Placement Consultants•Evansville, IN

1d•Onsite

About The Position

BizTek People is in search for an experienced Dental Network Specialist for our client in Evansville, IN! Job Summary The Credentialing Specialist is responsible for coordinating initial credentialing and re-credentialing applications for network dentists in accordance with organizational standards and regulatory requirements. This role also manages provider data, network updates, and provider directories.

Requirements

Minimum of 3+ years of provider credentialing experience
Strong working knowledge of credentialing standards and regulatory requirements
Experience with CAQH and NPDB required
Tech-savvy with credentialing systems and proficient in Microsoft Excel
Prior insurance industry experience and familiarity with industry terminology
High School Diploma or GED required
Strong attention to detail and organizational skills

Responsibilities

Coordinate initial credentialing for 12–16 new providers per month (volume may vary weekly)
Manage re-credentialing of providers on a three-year cycle
Gather, verify, and maintain documentation in accordance with credentialing policies and procedures
Perform primary source verification, including licensure, DEA certificates, malpractice coverage, claims history, CAQH, and National Practitioner Data Bank (NPDB) review
Maintain accurate provider files and audit trails
Prepare completed credentialing files for leadership review and signature
Set up providers in the internal system
Pull reports and data for monthly sanction meetings
Run quarterly provider adequacy and accessibility reports
Maintain and update Commercial and Medicare provider directories
Upload provider directories to Medicare and health plans monthly
Process provider updates and terminations, including member notifications
Manage provider contracts and fee schedules
Complete network verifications to meet state requirements
Support accounting with TIN verification as needed
Serve as a primary contact for provider offices and leased networks
Coordinate reporting and provider data requests with external network partners