Credentialing Specialist

Description

About us:

At Orthodontic Experts, we are committed to delivering exceptional patient care and setting the standard for orthodontic excellence. With over 30 locations throughout the greater Chicagoland area, Wisconsin, and Indiana, and continued growth ahead, we are focused on transforming smiles and making a meaningful impact in the communities we serve.

We are looking for team members who are passionate about high-quality care and align with our Core Values:

• Accountability
• Continuous Improvement
• Inclusion
• Integrity
• Respect
• Teamwork
• Transparency

If you are seeking an opportunity to grow your career in a purpose-driven, patient-centered organization, we encourage you to apply.

Job Description:

The Credentialing Specialist will provide credentialing services to support the enrollment, maintenance, and compliance of provider credentials with various insurance payers, state licensing boards, and regulatory entities. All services shall be completed in accordance with company procedures and applicable industry and HIPAA-compliant standards. 

Duties include but are not limited to:

Application Management & Enrollment 

• Complete and submit credentialing and re-credentialing applications to insurance payers and networks. 
• Track and follow up on application statuses with payers and other regulatory agencies. 
• Verify provider licensure, certifications, education, and professional history. 

Data Maintenance & Portals 

• Maintain accurate, up-to-date provider records and documentation within internal systems. 
• Manage provider rosters and update primary payer portals. 
• Document all credentialing activities, timelines, and communications thoroughly and accurately. 

Communication & Escalation 

• Communicate regularly with internal management, healthcare providers, and third-party payers to ensure strict credentialing deadlines are met. 
• Respond promptly to credentialing-related requests or issues from management or external parties. 
• Escalate application delays, payer denials, or potential compliance risks to management as needed. 

Compliance & Reporting 

• Assist in preparing reports, provider rosters, or specialized audits related to credentialing and compliance. 
• Ensure all handled workflows meet strict HIPAA privacy regulations and organizational standards. 

Other duties as assigned.

Requirements

• High School Diploma or equivalent required; Associate or Bachelor's degree preferred. 
• Exceptional attention to detail, strong administrative follow-through, and proficiency with provider enrollment portals.  
• Ability to manage multiple priorities across several locations. 
• High level of discretion and professionalism when handling sensitive information. 
• Proven success navigating and resolving complex payer enrollment delays, administrative blocks, or claim rejections due to credentialing. 

Preferred Qualifications 

• Experience within a Dental Support Organization (DSO), healthcare network, or construction is a plus. 
• 1 to 3 years of healthcare credentialing or provider enrollment experience preferred. 
• Certified Provider Credentialing Specialist (CPCS) is a strong plus. 
• Fluency in a second language (such as Spanish) to better assist a diverse patient population. 

Work Environment 

• On-site structure; office environment.
• Fast-paced, service-oriented environment with frequent interaction with clinical and administrative teams. 

Physical Requirements 

• Sitting or standing posture / Repetitive hand and finger use / Visual acuity / Written and verbal communication / Light mobility and lifting. 

Working Hours/ Location:

• Location: 1700 W Higgins Rd Des Plaines, IL 60018
• Full-Time/Non-exempt
• Hours: 8:00 AM to 5:00 PM

Benefits (for our full-time employees):

• Paid Training
• Paid Time Off
• Holiday Pay
• Medical, Dental, Vision, and Life Insurance
• Accident Insurance
• Short-Term Disability
• Long-Term Disability
• Employee Assistance Program
• Health Savings Account
• Dependent Care Account
• 401(k) and matching
• Pet Insurance
• Tuition Assistance Program
• Identity Theft Protection
• MetLife MetLaw Legal Insurance
• Transit Reimbursement - Commuter Account
• Free and discounted Orthodontic Treatments