Credentialing Specialist

What you'll do

The Credentialing Specialist's primary role is to collect the appropriate provider documentation to enroll the provider in all of the dental plans with which Great Expressions is contracted and the provider is eligible with. This position will be responsible for submitting initial enrollment applications, and all associated follow up on those applications. The Credentialing Specialist will also be responsible for verifying the accuracy of all submitted credentialing and enrollment information.

This position is located at the GEDC Practice Support Center in Southfield, MI and would require an on-site presence at least four days per week. During the initial training period, full in-office attendance (five days per week) will be required.

What you'll bring to the team

• Responsible for preparing enrollment applications for new and established providers within a region
• Ensures that applications are completed accurately, comprehensively and are sent out in a timely manner
• Organizes credentialing-related files and verifies that required documents for applications are collected from providers
• Validates that information on required documents match enrollment applications and ensure there are no discrepancies
• Recognizes, investigates, and validates discrepancies in information obtained from providers
• Submits enrollment applications, stores record of submissions and provides payors with additional information to if requested
• Follows up with payors proactively on pending applications in advance of a provider's start date
• Collects effective date from payors and stores confirmation of enrollment
• Maintains practice management system with accurate information submission dates, follow-up dates and effective dates as well other required data
• Responsible for Medicaid enrollment applications and re-validations prior to expiration date
• Responds to directory validation and other such requests from payors
• Proactively provides updates to regional team on providers and statuses on enrollment with payors and responds to any ad-hoc inquiries
• Demonstrates the ability to effectively prioritize tasks and set short/long term goals to achieve them
• Expresses thought clearly, concisely, and effectively both verbally and in writing. Ensures a free flow of information and communication upward, downward, and across the organization by actively listening
• Compiles, evaluates, and presents the provider specific data collected for review by one or more decision making bodies
• Assist with all re-credentialing request
• Sorts and handles mail
• Other tasks as requested by direct Manager

What we require you have

• Associates degree or equivalent credentialing experience

• Prior experience with dental/health credentialing & provider enrollment
• CPCS or CPMSM certification a plus
• Proficiency in Microsoft Outlook and Excel
• Excellent Communication skills and customer focus
• Analytical and problem solving skills with a passion for detail & accuracy
• Reliability and flexibility with time committed to the position
• Excellent organizational and time management ability

About GEDC

Since 1982, Great Expressions has been at the forefront of dental innovation, setting the standard for exceptional care and unforgettable patient experiences. Now, we're entering a new era of transformation, and we want you to be a part of it. Our recently appointed leadership team brings over a century of collective dental expertise and is backed by dynamic investment support to pave the way for groundbreaking changes. We're channeling our resources and energy into revolutionizing our technology platform, expanding service offerings, and creating a personalized patient experience that goes beyond the expected. At Great Expressions, we're not just transforming dentistry; we're investing in the growth and development of our team. Join us and be a part of a career that blends innovation and professionalism, where your contribution shapes the future of dental excellence.

#IND8

GEDC is committed to diversity and inclusion and is proud to be an equal opportunity employer. All qualified applicants are welcomed and encouraged to apply.

• Job Family: Credentialing
• Job Function: Revenue Cycle
• Pay Type: Hourly