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Dental Billing and Credentialing Specialist

Dental Billing and Credentialing Specialist

MCHCMilwaukee, WI, United States
20 hours ago
Job type
  • Full-time
Job description

Job Title : Dental Billing and Credentialing Specialist

Reports To : Chief Financial Officer

Department : Dental Clinic

Position Summary :

The Dental Billing and Credentialing Specialist plays a critical role in supporting the dental

department's financial operations and provider enrollment processes. This position ensures

accurate and timely submission of dental claims, manages follow-ups and denials, and maintains

current provider credentials in compliance with Medicaid, Medicare, and private insurance

requirements.

Key Responsibilities :

Billing and Revenue Cycle Support

  • Prepare, review, and submit dental claims to insurance carriers via electronic and / or

paper submission.

  • Post insurance payments and patient payments into the system accurately and reconcile
  • accounts.

  • Monitor outstanding claims and perform timely follow-ups to resolve denials, rejections,
  • and underpayments.

  • Verify patient insurance eligibility and benefits prior to services.
  • Generate monthly billing reports and assist with audits or financial reconciliations.
  • Communicate with dental providers and front desk staff to ensure documentation and
  • billing accuracy.

    Credentialing and Enrollment

  • Coordinate initial credentialing and re-credentialing of dental providers with payers
  • (Medicaid, Medicare, commercial insurers).

  • Maintain up-to-date records of CAQH profiles, NPI registrations, and licensing
  • information.

  • Track and manage credentialing deadlines and revalidation schedules to ensure no lapse
  • in billing privileges.

  • Submit provider enrollment applications and respond to payer correspondence as needed.
  • Compliance and Documentation

  • Ensure compliance with HRSA, state, and payer-specific regulations regarding billing
  • and credentialing.

  • Maintain accurate and organized records for audits and internal / external reporting.
  • Stay updated with dental billing codes (CDT), payer policies, and credentialing standards.
  • Qualifications :

  • High school diploma or equivalent required; associate degree or higher in healthcare
  • administration or related field preferred.

  • Minimum 2 years of experience in dental billing and credentialing, preferably in an
  • FQHC or community health center setting.

  • Strong knowledge of CDT codes, insurance billing, and credentialing processes.
  • Proficiency with dental EHR / PM systems (e.g., Dentrix, Eaglesoft, Open Dental).
  • Familiarity with Medicaid, Medicare, and managed care plans.
  • Excellent organizational, communication, and problem-solving skills.
  • Ability to handle sensitive information with discretion and maintain HIPAA compliance.
  • Preferred :

  • Experience with HRSA compliance and UDS reporting requirements.
  • Bilingual (e.g., Spanish, Arabic, Hmong) a plus.
  • Certified Dental Coder (CDC) or similar credential preferred.
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    Credentialing Specialist • Milwaukee, WI, United States

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