Credentialing Specialist

Title: Credentialing Specialist 
Practice: Oral Surgery Partners
Location: Remote
Office Hours: 8am to 5pm CST

Position Purpose:

The Credentialing Specialist is responsible for ensuring that all Oral Surgery Partners (OSP) providers are properly credentialed and enrolled with applicable insurance companies, including Medicare and Medicaid, and for maintaining accurate provider records. This role supports the billing department by managing claims, verifying insurance information, and ensuring timely reimbursement, while maintaining compliance with local, state, and federal regulations. The Credentialing Specialist also serves as a key point of contact for providers, vendors, and colleagues, and provides backup support for insurance coordination and related billing functions, contributing to the efficiency and accuracy of the organization’s revenue cycle operations.

Essential Functions:

Provider Credentialing & Enrollment

• Ensure all OSP doctors are credentialed with all applicable insurance companies.
• Enroll new doctors into applicable insurance companies.
• Update credentialing for all doctors/offices annually.
• Opt-out/Opt-in to Medicare/Medicaid with CMS.
• Opt-out of previously in-network insurance companies if necessary.
• Keep updated files for all doctors, including State License, NPI, Practice information, DEA license, BNDD, Medicare/Medicaid numbers, etc.

Claims Management & Billing Support

• Be a part of the billing department (manage and file claims, send additional information to insurance companies, check outstanding claims, enter and manage payments, etc.).
• Process claims denials and resend with necessary materials.
• Write narratives when insurance requests additional information.
• Maintain timely reimbursement of all claims.
• Review subscriber information for accuracy prior to submission.
• Attach necessary X-rays, narratives, and anesthesia records prior to submission.

Insurance & Reimbursement Administration

• Annually negotiate new fees for all providers.
• Proactively research and investigate unusual benefits or network discrepancies.
• Understand how to fill out and send W-9 forms.

Customer Service & Communication

• Answer phone and field insurance questions.
• Professionally work with clients, vendors, supervisors, and coworkers

Compliance

• Comply with all local, state, and federal guidelines

Qualifications:

Education/Certification:

• High school diploma or equivalent required.
• Bachelor’s degree in healthcare administration, business, or a related field can be a plus, but not always required.

Experience:

• Experience with medical/dental billing
• 4+ years of Credentialing experience required
• 4+ years of dental experience required
• Familiarity with ICD-10 and CDT codes

Performance Requirements:

• Strong organizational skills
• Excellent communication and customer/patient-service capabilities.
• Ability to handle multiple tasks
• Ability to work in fast-paced environment
• Analytical and detail-oriented
• Able to work independently with exceptional initiative and sound judgment
• Ability to handle sensitive information confidentially.
• Positive attitude, change advocate, able to lead by example

• We offer Medical, Dental, and Vision Insurance plans to our full-time employees.
• Two out of the three medical plans offered include Health Savings Account (HSA) eligibility.
• Company-paid Life, AD&D and Long-Term Disability coverage.
• Additional Voluntary Life and AD&D Insurance for you and your family!
• Voluntary Short-Term Disability Insurance available to you as well
• Dependent Care Flexible Spending Account (FSA) offered.
• Immediately begin saving for retirement through our 401(k) starting with very first paycheck!
• Employer 401(k) contribution and Profit Sharing after six months of employment
• PTO and 8 Paid holidays for fulltime employees!

DISCLAIMER

The above statements are intended to describe the general nature and level of the work being performed by people assigned to this work.  This is not an exhaustive list of all duties and responsibilities.  OPS’s management reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.