Credentialing Specialist
Sage Dental · Boca Raton, FL · 1 wk ago
HealthcareFull-time
Remote position supporting delegated credentialing for General and Specialty Dentists.
About the role
Organize, maintain, and verify all aspects of the delegated credentialing process in compliance with legal, regulatory, and NCQA guidelines.
Responsibilities
- Audit Provider Licensure Files to NCQA standards
- Pull Monthly Delegated Verification Files in accordance with NCQA
- Navigate delegated verification websites (e.g., National Provider Data Base)
- Process Initial and Re-Credential Delegated files
- Prepare and present provider files for internal and external audits
- Upload and update systems/software with new documents
- Request and obtain licensure renewals via licensure portals
- Perform Clearinghouse and Manual Education Verifications
- Conduct Manual Hospital Privileges Verifications
- Verify Board Certifications through appropriate portals
- Distinguish between similar credentials (e.g., Malpractice, Diplomas)
- Coordinate, monitor, and process internal re-credentialing to NCQA guidelines
- Interpret and act on Attestation questions, actions, exclusions, and explanations
- Communicate effectively with providers, educators, and internal departments
- Assist offices and internal departments with credentialing issues
- Multi-task in a fast-paced environment and handle additional projects as assigned
Requirements
- High School Diploma required
- Minimum 2–3 years’ experience in Healthcare Credentialing (Dental preferred)
- Designated workspace with high-speed internet and optional hot-spot access
Skills
- Excellent verbal and written communication
- Well-organized, detail-oriented, and able to multi-task
- Proficiency with Microsoft Office (Word, Excel, Outlook) and Adobe
- Ability to function with minimal supervision and prioritize tasks
- Knowledge of Credentialing Committee structure