Dental Care Alliance’s mission is to advance the practice of dentistry by partnering with and supporting dental professionals to create a lifetime of healthy smiles. Headquartered in Sarasota, Florida, DCA currently supports over 400 allied practices and supports over 900 dentists across over 20 States. DCA’s allied practices represent all dental specialties and treat patients under more than 150 brand names.

The Credentialing and Enrollment Specialist will report to the Senior Manager of Credentialing and Enrollment to oversee the credentialing process for all providers within their assigned territory. This role is critical in ensuring that all providers are accurately credentialed with insurance payors and maintain compliance with regulatory standards.

· Credentialing Execution: Manage the non-delegated credentialing process for new and existing providers, ensuring timely and accurate completion of all credentialing and re-credentialing applications.

· Insurance Payor Relationships: Act as the primary liaison for all insurance payor relationships in the assigned area, resolving any issues related to provider credentialing.

· Compliance: Ensure full compliance of all credentialing activities with state, federal, and organizational regulations and standards.

· Documentation: Maintain precise and up-to-date records of all credentialing activities, including applications, approvals, and renewals.

· Collaboration: Provide leadership and mentorship to credentialing specialists, providing guidance and support to ensure high performance and professional development.

· Problem Resolution: Proactively identify, address, and resolve issues or discrepancies that arise during the credentialing process.

· Reporting: Generate and analyze credentialing reports to identify trends, risks, and opportunities for improvement.

Core Competencies

Industry Expertise: Demonstrated in-depth understanding of dental insurance industry practices, Medicaid and Veteran’s Administration enrollment procedures, regulations, and trends, including a broad understanding of billing and cash collection nuances, to maximize insurance payments and benefits.

Analytical Skills: Advanced analytical and problem-solving abilities to interpret insurance data, identify trends, make informed decisions based on information provided by DCA’s credentialing SAAS reports

Execution Experience: Proven history of collaborating with high-performing teams to achieve operational goals.

Expectations

Collaboration: Work closely with cross-functional teams, including revenue cycle, operations, and clinical leadership, to align insurance plan management strategies with overall organizational goals.

Continuous Improvement: Continuously identify opportunities for process improvement, technology adoption, and innovative solutions to enhance insurance plan management practices within the DSO.

Minimum of 4 years direct dental credentialing and enrollment experience

· Willingness to travel up to 5%

· Proven ability to work independently in a remote environment