United Dental Corporation is hiring a Credentialing Administrator to own end-to-end provider credentialing and payer enrollment for our multi-state Dental Service Organization. This role ensures our providers are credentialed efficiently to deliver in-network care, managing data, leading transitions, analyzing contracts, and serving as the primary point of contact with insurance carriers.
What You'll Do
- Collect, verify, and maintain comprehensive provider documentation, including licenses, malpractice insurance, and NPI.
- Maintain a centralized, auditable source of truth with version control and expiration tracking for all credentials.
- Manage CAQH profiles, NPPES updates, Medicaid IDs, payer rosters, and ensure data accuracy prior to submission.
- Conduct OIG/SAM exclusion checks and state license verification to ensure compliance.
- Lead end-to-end Change of Ownership (CHOW) processes, including contract updates, EFT/ERA transitions, and portal access changes.
- Create and manage CHOW project plans with clear timelines and track milestones to validate post-transition performance.
- Advise leadership on optimal payer participation by state, location, and provider specialty.
- Prepare, submit, and track initial and recredentialing applications across commercial, government, and dental carriers.
- Monitor expirations and recredentialing cycles to prevent network lapses and respond to payer requests for information.
- Organize and maintain payer contracts and fee schedules with version control, comparing them against benchmarks.
- Analyze contract terms to summarize financial and operational impacts and partner with Finance to model reimbursement.
- Coordinate fee schedule implementation and audit initial payments for accuracy.
- Serve as the primary contact for payer representatives, scheduling regular check-ins and resolving escalations.
- Communicate credentialing updates, contract analyses, and outcomes clearly to internal stakeholders.
What We're Looking For
- 3–5+ years of hands-on healthcare credentialing experience, with dental strongly preferred.
- Proven experience supporting multi-provider, multi-location, and multi-state environments.
- Practical experience with CAQH ProView, payer portals (e.g., Availity, UHC, Aetna), NPPES, and Medicaid portals.
- Demonstrated success leading CHOW transitions for payers.
- Strong organizational, documentation, and follow-up skills with high attention to detail.
- Proficiency with Microsoft 365, including Excel, Teams, and SharePoint.
- Clear, professional written and verbal communication skills.
Nice to Have
- NAMSS CPCS or CPMSM certification.
- Prior DSO experience and familiarity with delegated credentialing processes.
- Basic analytics skills, such as building Excel models, performing variance analysis, and tracking KPIs.
- Experience with EFT/ERA enrollment tools and Revenue Cycle Management (RCM) systems.
Technical Stack
- Credentialing: CAQH ProView, payer portals (Availity, UHC, Aetna, Cigna, Delta Dental, MetLife), NPPES, Medicaid portals
- Productivity: Microsoft 365 (Excel, Teams, SharePoint)
- Specialized Tools: EFT/ERA enrollment tools, RCM systems
Team & Environment
You will join the Credentialing & Payer Relations department within Revenue Cycle Management, reporting to the Director of Revenue Cycle Management. Our culture emphasizes true ownership and strategic impact, fostering strong cross-functional partnerships in a remote setting.
Benefits & Compensation
- Salary range: $55,000–$70,000 per year (approximately $26–$34 per hour)
- Medical, Dental, and Vision insurance
- 401(k) retirement plan with a 4% company match
- Paid Time Off and 7 paid holidays
- Employee Assistance Program offering free confidential counseling and support
- Voluntary benefits including pet insurance and identity theft protection
- All necessary Personal Protective Equipment (PPE) provided
Work Mode
This is a fully remote position, open to candidates based anywhere in the United States.
United Dental Corporation is an equal opportunity employer.
