Revenue Cycle & Credentialing Specialist

Company: Partnerships for Dentists

Location: Remote

Department: Revenue Cycle Management

Employment Type: Full-time

Position Summary

The Revenue Cycle & Credentialing Specialist is responsible for the accurate and timely submission of dental claims, proactive follow-up to ensure appropriate reimbursement, and the management of provider credentialing and recredentialing activities. This role plays a critical part in optimizing cash flow, maintaining provider enrollment with insurance payers, and ensuring compliance with payer and regulatory requirements.

Key Responsibilities

Revenue Cycle Management

• Submit clean, accurate claims to commercial and government payers in a timely manner.
• Monitor claim status within Inside Desk.
• Identify, research, and resolve claim rejections and denials.
• Correct and resubmit denied or rejected claims as needed.
• Escalate unresolved or complex claim issues as appropriate.
• Maintain detailed documentation of claim activity and follow-up efforts within Inside Desk.
• Communicate effectively with the offices you support regarding claim status and reimbursement issues.
• Meet productivity and quality benchmarks established by the organization.

Credentialing

• Coordinate initial credentialing, recredentialing, and provider enrollment with commercial insurance carriers and government payers.
• Prepare, submit, and track credentialing applications to ensure timely approval and enrollment.
• Maintain accurate provider credentialing records, licenses, certifications, and supporting documentation.
• Monitor credentialing and recredentialing deadlines to prevent lapses in payer participation.
• Communicate with insurance payers to resolve credentialing and enrollment issues.
• Collaborate with providers and internal teams to gather required documentation and ensure timely completion of credentialing requirements.
• Maintain compliance with payer, regulatory, and organizational credentialing standards.

Qualifications

• High school diploma or equivalent required; associate degree preferred.
• 1–3 years of experience in dental billing, claims submission, revenue cycle management, or provider credentialing.
• Working knowledge of CDT coding concepts.
• Experience with claim follow-up, denial management, and payer portals.
• Familiarity with commercial insurance, Medicare, and Medicaid billing processes.
• Experience with provider credentialing, enrollment, and recredentialing processes is strongly preferred.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and meet deadlines.
• Proficient in electronic health record (EHR) and practice management systems.
• Strong written and verbal communication skills.

Preferred Qualifications

• Experience with Eaglesoft, Dentrix, Open Dental, Dental Exchange, and Inside Desk.
• Knowledge of provider enrollment, credentialing platforms, and payer-specific requirements.
• Experience managing credentialing for multiple providers and locations.
• Knowledge of appeals processes and payer-specific reimbursement requirements.

Benefits

• Competitive compensation
• Medical, dental, and vision insurance
• Paid time off and holidays
• Retirement plan with employer contribution