Credentialing Administrator

Credentialing Subject Matter Expert / Administrator Full-Time | Fully Remote (U.S.-Based) Department: Credentialing & Payer Relations (RCM) Reports To: Director of Revenue Cycle Management Compensation: $65,000–$75,000 annually (DOE) Role Overview We are seeking a Credentialing Subject Matter Expert to own provider credentialing and payer enrollment for a multi-state Dental Service Organization (DSO). This is a full-time, fully remote corporate role responsible for setting standards, managing timelines, and driving accountability across credentialing, recredentialing, and Change of Ownership (CHOW) initiatives. This is not a task-based or entry-level credentialing position. You will serve as the internal expert, managing payer relationships, tracking complex projects, and ensuring providers are enrolled accurately and on time so practices remain compliant and revenue flows predictably. Why This Role Is Different

• True ownership: End-to-end responsibility for credentialing, recredentialing, and CHOWs—not just application submission
• Strategic impact: Advise leadership on payer participation, network strategy, and reimbursement implications
• Complex, meaningful work: Support multiple states, TINs, and frequent transitions
• Relationship-driven: Act as the primary liaison with payer representatives
• Remote with autonomy: Trusted to build scalable processes that stick

Key Responsibilities

Credentialing & Provider Data Management

• Manage provider credentialing and enrollment from start to finish
• Collect, verify, and maintain provider data (licenses, DEA/CSR, CAQH, NPI, W-9, malpractice, etc.)
• Maintain a centralized, auditable source of truth with expiration tracking
• Conduct license verification, OIG/SAM checks, and compliance reviews

CHOWs & Project Management

• Lead CHOW transitions across payers, including rosters, EFT/ERA, portals, and contracts
• Build and manage credentialing project plans with clear timelines and risk mitigation
• Track milestones and validate post-transition performance (claims, EFT accuracy, network status)

Payer Enrollment & Recredentialing

• Prepare, submit, and track initial and recredentialing applications
• Proactively manage expirations and recredentialing cycles
• Follow up on RFIs, escalate delays, and document outcomes
• Maintain payer portals and ensure providers/sites display correctly as in-network

Contracts & Fee Schedules

• Organize and maintain payer contracts and fee schedules
• Review and summarize reimbursement and operational impacts
• Partner with Finance and RCM to audit payments and support payer strategy decisions

Carrier & Stakeholder Communication

• Serve as primary point of contact with payer representatives
• Manage escalations related to credentialing, CHOWs, and rosters
• Provide clear status reporting and updates to leadership and cross-functional teams

What We’re Looking For

• Proven experience in provider credentialing and payer enrollment (dental preferred)
• Strong payer relations and direct carrier communication experience
• Project management mindset with strong tracking and reporting skills
• Ability to anticipate delays and understand downstream revenue impacts
• Comfortable working independently in a full-time remote environment
• Experience supporting multi-state organizations and CHOWs strongly preferred

Why Join Us

• Full-time, fully remote corporate role
• High visibility and real ownership
• Opportunity to build structure, standards, and long-term impact
• Collaborative environment across Ops, Finance, RCM, and Leadership
• 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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