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 reconcileaccounts.
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 andbilling 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 licensinginformation.
Track and manage credentialing deadlines and revalidation schedules to ensure no lapsein 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 billingand 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 healthcareadministration or related field preferred.
Minimum 2 years of experience in dental billing and credentialing, preferably in anFQHC 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.