Senior Credentialing & Insurance Specialist

Summary

The Senior Credentialing and Insurance Specialist will be the in-house insurance expert on plan details, provider credentialing and provider licensure. The Senior Credentialing and Insurance Specialist will impact results by delivering the Espire mission to team members and patients by living joyfully, leading bravely, and creating greatness.

Responsibilities

• Manage all insurance payor relationships
• Provide strategic analysis on insurance plan utilization
• Ensure all providers are appropriately credentialed
• Manage all provider malpractice enrollment
• Track all provider licensure
• Input all fee schedules
• Provide support on local market fee analysis
• RCM functions including but not limited to, insurance plan strategy, claims management, insurance payment posting, verifications, and aging reports
  
  

Education/License Requirements

• High school diploma or GED, required
• Bachelor’s Degree in Business or related field, or equivalent experience, preferred
  
  

Experience Requirements

• 5 years’ experience in the dental insurance field, required
  
  

Skills Requirements

• Expert level knowledge in dental insurance
• Proactive problem solving
• Analytical approach to providing recommendations
• Strong organizational skills
• Understanding of compliance and regulatory standards pertinent to scope of activities of job
• Ability to work in a team environment required
• Excellent coaching skills
  
  

Physical Requirements

Level 1: A combination of sitting, standing and walking with little requirement for physical effort. There may be a requirement to exert light physical effort for short periods.

Supervisory Responsibilities

No supervisory responsibility.

Travel Requirements

1% - 10% travel required.