Credentialing Administrator

Credentialing Administrator (Multi-State Dental Service Organization) Full Time: (Monday - Friday) Location: United Dental Corporation - Remote Pay: $55k–$70k/year (≈ $26–$34/hour) Credentialing Administrator Department: Credentialing & Payer Relations (Revenue Cycle Management) Reports To: Director of Revenue Cycle Management Location: Remote (U.S.-based) Role Overview The Credentialing Administrator owns end-to-end provider credentialing and payer enrollment for a multi-state Dental Service Organization (DSO). This role manages provider data, leads Change of Ownership (CHOW) transitions, submits and tracks credentialing applications, evaluates payer contracts and fee schedules, and serves as the primary point of contact with insurance carriers. Success in this role ensures providers are enrolled on time, practices remain compliant, claims pay correctly, and leadership has clear insight into payer participation decisions. Why This Role Is Different

• True ownership, not task-based credentialing: This role owns end-to-end provider onboarding, CHOW transitions, and payer participation strategy—not just application processing.
• Strategic impact: You’ll advise leadership on where and how the organization participates with payers, influencing access, reimbursement, and growth decisions across multiple states.
• Complex, meaningful work: Support a multi-site, multi-TIN Dental Service Organization with frequent CHOW activity and varied payer landscapes.
• Strong cross-functional partnership: Work closely with Operations, Finance, RCM, Compliance, and Practice Leadership to ensure credentialing decisions translate into clean claims and predictable revenue.
• Remote with autonomy: Fully remote role with trust, accountability, and the ability to build scalable processes that actually stick.
• Relationship-driven: Act as the primary liaison with payer representatives and have the authority to escalate, negotiate, and resolve issues.

Key Responsibilities 1. Provider Data & Credentialing Management

• Collect, verify, and maintain provider documentation (licenses, DEA/CSR, malpractice, CAQH, NPI, W-9, education, board certifications, CE).
• Maintain a centralized, auditable source of truth with version control and expiration tracking.
• Manage CAQH profiles, NPPES updates, Medicaid IDs, PECOS (if applicable), and payer rosters.
• Ensure data accuracy prior to submission and resolve discrepancies (name, address, taxonomy, TIN, EFT/ERA details).
• Conduct OIG/SAM exclusion checks and state license verification.
• Ensure HIPAA compliance and internal data governance standards.

2. CHOW Transitions & Network Strategy

• Lead end-to-end CHOW processes across payers, including contract updates, roster changes, EFT/ERA transitions, and portal access.
• Create and manage CHOW project plans with clear timelines and risk mitigation.
• Advise leadership on optimal payer participation by state, location, and specialty.
• Track CHOW milestones and validate post-transition performance (claims paid, EFT accuracy, portal access).

3. Credentialing & Recredentialing Applications

• Prepare, submit, and track initial and recredentialing applications across commercial, government, and dental carriers.
• Monitor expirations and recredentialing cycles to prevent network lapses.
• Respond to payer RFIs, escalate delays, and document all follow-ups.
• Maintain accurate payer portal access and ensure providers/sites display correctly as in-network.
• Establish and meet SLAs for submission quality, turnaround time, and follow-up cadence.

4. Contract & Fee Schedule Review

• Organize and maintain payer contracts and fee schedules with version control.
• Compare fee schedules against benchmarks (top CDT codes, regional rates, Medicaid/Medicare references).
• Analyze contract terms and summarize financial and operational impacts.
• Partner with Finance and RCM to model reimbursement outcomes and support renegotiations or terminations.
• Coordinate implementation of fee schedules and audit initial payments for accuracy.

5. Carrier Relationship Management

• Serve as the primary contact for payer and carrier representatives.
• Schedule and lead regular check-ins and QBRs.
• Resolve escalations related to credentialing, rosters, CHOWs, and contracts.
• Communicate updates and outcomes to internal stakeholders.
• 3–5+ years of healthcare credentialing experience (dental strongly preferred).
• Experience supporting multi-provider, multi-location, and multi-state environments.
• Hands-on experience with CAQH ProView, payer portals (e.g., Availity, UHC, Aetna, Cigna, Delta Dental, MetLife), NPPES, and Medicaid portals.
• Proven experience leading CHOW transitions.
• Strong organizational, documentation, and follow-up skills.
• Proficiency with Microsoft 365 (Excel, Teams, SharePoint).
• Clear, professional communication skills.

Preferred

• NAMSS CPCS or CPMSM certification.
• Prior DSO experience and familiarity with delegated credentialing.
• Basic analytics skills (Excel models, variance analysis, KPI tracking).
• Experience with EFT/ERA enrollment tools and RCM systems.

Core Competencies

• Project Management: Manages complex, multi-state workstreams effectively.
• Analytical Thinking: Translates contracts and fee schedules into insights.
• Stakeholder Communication: Provides clear updates to leadership and partners.
• Process Improvement: Builds scalable, compliant workflows.
• Compliance & Confidentiality: Protects sensitive data and meets regulatory standards.
• Full benefits package (for 25+ hours/week):
• Medical, Dental, Vision
• 401(k) with 4% match
• Paid Time Off and 7 paid holidays
• Employee Assistance Program: Free confidential counseling and support
• Voluntary benefits: Pet insurance, identity theft protection, and more
• All PPE provided – safe and compliant workplace

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