Credentialing Specialist

About Us

OrthoSynetics is a national healthcare services company headquartered in Metairie, LA. OrthoSynetics supports 300+ orthodontic and pediatric dental practices in the United States with a focus on improving revenue growth and profitability. Services provided are revenue cycle management, marketing, human resources, purchasing, consulting, real estate services, accounts payable, accounts payable, accounts receivable, and collections. Mission Statement We believe practice success happens when every part works together. That’s why we focus on helping our clients grow, collect, and save while ensuring a frictionless patient experience. Benefits: Medical, Dental, and Vision Insurance 401k Short term disability and critical illness For Corporate employees: paid parking $20k complimentary life insurance policy Job Purpose The Credentialing Specialist is responsible for performing the credentialing and enrollment processes for dental providers, ensuring compliance with regulatory requirements, and maintaining accurate credentialing records. The ideal candidate will have strong analytical skills, a deep understanding of credentialing principles, and the ability to work efficiently in a fast-paced environment. Duties and Responsibilities Credentialing Process Management: Manage the credentialing process for dental providers, from initial application through re-credentialing with insurance carriers. Review credentialing applications, verifying accuracy, completeness, and compliance with organizational policies, regulatory standards, and accreditation requirements. Collect, validate, and maintain documentation related to provider credentials, including licenses, certifications, education credentials, and professional references. Coordinate and communicate with dental providers, licensing boards, educational institutions, and other relevant entities to obtain and verify credentialing information. Provider Enrollment and Credentialing: Facilitate the enrollment process for dental providers with insurance companies. Prepare and submit enrollment applications with insurance carriers, ensuring timely submission and follow-up. Monitor the status of enrollment applications, track progress, and address any issues or delays. Complete re-credentialing requests with insurance carriers. Complete directory verification requests. Complete provider contracting and network participation inquiries. Assist in collecting the data for contract fee analysis. Complete demographic change requests with insurance carrier contracts. Complete contract terminations as requested by the providers. Update and maintain the CAQH/ADA profiles for providers. Assist with researching potential plan enrollments. Assist the PFS department with contracting or credentialing issues on claims and benefit verifications. Compliance and Quality Assurance: Ensure compliance with regulatory requirements, accreditation standards, and organizational policies related to credentialing and provider enrollment. Conduct regular audits of credentialing files and databases to ensure accuracy, completeness, and timeliness of credentialing activities. Identify opportunities for process improvement and participate in quality assurance initiatives to enhance credentialing processes and ensure compliance. Database Management and Reporting: Maintain accurate and up-to-date credentialing data in electronic databases and credentialing systems. Generate reports and summaries of credentialing activities, status updates, and compliance metrics for management review. Provide data analysis and recommendations to support decision-making and process optimization. Qualification Requirements Education and Experience: Associate's degree in healthcare administration, business administration, or a related field preferred; equivalent work experience may be considered. Minimum of 2-3 years of experience in credentialing, provider enrollment, or healthcare administration required. Knowledge of credentialing principles, regulations, and industry standards (e.g., NCQA, URAC, Joint Commission) preferred. Technical Skills: Proficiency with computer software and database management, including Microsoft Office Suite (Word, Excel, Outlook) Monday.com, and credentialing software systems. Familiarity with NPPES, CAQH, state dental licensing boards, and insurance carrier portals. Ability to comprehend insurance carrier contracts and fee schedules to interpret for providers. Soft Skills: Strong analytical and problem-solving skills, with the ability to interpret complex credentialing requirements and regulations. Excellent organizational skills and attention to detail, with the ability to manage multiple tasks and deadlines effectively. Exceptional communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders. Ability to maintain confidentiality and handle sensitive information with discretion and professionalism.

Work Environment

Requires sitting with occasional walking, standing, kneeling, or stooping Requires regular talking and hearing Requires close vision and the ability to focus Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. The noise level is usually moderate. Disclaimer The above statements are intended to describe the general nature and level of work being performed by an employee assigned to this classification. The above statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. We are an Equal Opportunity Employer and make employment decisions without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under applicable law. Apply To This Job