Delegated Credentialing Specialist

Job Summary

The Delegated Credentialing Specialist is responsible for managing the end-to-end credentialing lifecycle for providers participating with delegated dental payer networks. This role ensures providers are credentialed in accordance with delegated agreements, accreditation standards, payer requirements, and MB2 Dental policies while supporting timely provider onboarding and uninterrupted revenue generation.

Key Responsibilities

• 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.

Qualifications

• Minimum of 2 years of healthcare credentialing experience.
• Working knowledge of credentialing principles, primary source verification, provider lifecycle management, and compliance documentation.
• Experience using Credential Stream or a comparable credentialing platform preferred.
• 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.

Benefits

MB2 Dental offers a competitive compensation package that includes medical/dental/vision/life insurance, long and short-term disability, PTO, paid holidays, traditional and Roth 401(k) options, and more!