Dental Provider Network Account Executive

Enlightened, Inc.•Washington, DC

29d•$75,000 - $95,000•Hybrid

About The Position

The Dental Provider Network Account Executive is responsible for developing and maintaining strong relationships with participating dental providers while supporting the day-to-day operations of the provider network. This position serves as the primary liaison between the health plan and its contracted dental providers, ensuring providers are successfully credentialed, contracted, enrolled, and maintained within the network. The Dental Provider Network Account Executive partners with internal departments, delegated credentialing teams, providers, and external vendors to support provider onboarding, credentialing, contract administration, provider data management, operational issue resolution, and ongoing provider satisfaction. This role also ensures provider information is maintained accurately across multiple systems to support network integrity and timely claims processing.

Requirements

Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field, or an equivalent combination of education and experience.
Three (3) or more years of experience in provider network management, provider relations, credentialing, provider enrollment, contracting, or healthcare operations.
Experience supporting provider credentialing and enrollment activities.
Working knowledge of managed care, Medicaid, Medicare, or commercial health plans.
Strong organizational and time management skills with the ability to manage multiple priorities.
Excellent verbal and written communication skills.
Strong customer service and relationship management skills.
Proficiency with Microsoft Office, including Excel, Word, and Outlook.

Nice To Haves

Experience supporting dental provider networks.
Experience working with Skygen, LIFT, or similar provider management systems.
Experience with delegated credentialing.
Knowledge of provider contracting and provider lifecycle management.
Experience working with Federally Qualified Health Centers (FQHCs).
Knowledge of Medicaid provider enrollment and compliance requirements.
Provider Network Management
Provider Relations
Provider Credentialing
Provider Contracting
Provider Enrollment
Managed Care Operations
Medicaid
Dental Provider Networks
Provider Data Management
Regulatory Compliance
Claims Resolution
Cross-Functional Collaboration
Relationship Management
Process Improvement
Attention to Detail

Responsibilities

Manage the end-to-end provider credentialing and recredentialing process.
Coordinate new provider enrollment from application through approval.
Partner with delegated credentialing teams to ensure provider files are complete and regulatory requirements are met.
Follow up with providers to obtain missing documentation and resolve credentialing deficiencies.
Prepare provider contracts and coordinate execution with internal leadership.
Maintain accurate provider records within LIFT and other provider management systems.
Coordinate provider site visits required for credentialing and recredentialing.
Support provider contracting activities, including new provider onboarding and ongoing provider maintenance.
Manage provider additions, terminations, demographic updates, practice location changes, and provider profile maintenance.
Maintain accurate provider information within Skygen to support claims processing and network operations.
Coordinate provider site visits with American Dental Systems.
Investigate and resolve provider claims and reimbursement issues.
Serve as the primary operational contact for participating dental providers.
Build and maintain strong relationships with Federally Qualified Health Centers (FQHCs), private dental practices, and group dental practices.
Monitor Medicaid Identification Numbers (MAIDs) for participating providers and provider groups.
Ensure provider records remain compliant with organizational, contractual, and regulatory requirements.
Identify opportunities to improve operational processes and workflow efficiencies.
Collaborate with internal departments to support provider network initiatives.
Participate in weekly, biweekly, and monthly operational meetings, as well as cross-functional projects.