Orthodontic Provider Credentialing Team Lead

Description

About us:

At Orthodontic Experts, we are committed to delivering exceptional patient care and setting the standard for orthodontic excellence. With 32 locations across 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:

We are seeking an experienced Orthodontic Provider Credentialing Team Lead to support provider enrollment, credentialing, recredentialing, payer maintenance, and provider data management for a growing orthodontic healthcare organization. This role helps ensure providers are enrolled accurately and efficiently with commercial insurance plans, Medicaid, and other third-party payers so providers can begin seeing patients without unnecessary delays. 

The right candidate is detail-oriented, organized, proactive with payer follow-up, and comfortable managing multiple applications, deadlines, and provider documentation at the same time.

Duties include but are not limited to:

• Serve as the primary resource for credentialing inquiries from internal departments, providers, insurance payers, and external partners. 
• Lead the credentialing and recredentialing process for orthodontic providers to ensure uninterrupted payer participation. 
• Coordinate and manage provider enrollment applications from preparation and submission through approval and implementation. 
• Facilitate credentialing and payer enrollment for newly affiliated practices and providers to support timely onboarding. 
• Organize and maintain provider credentialing records, ensuring all supporting documentation, renewal dates, and compliance requirements remain current. 
• Maintain and update provider documentation, including professional licenses, NPI records, malpractice insurance, curriculum vitae (CV), specialty certifications, CPR/BLS certifications, W-9 forms, and other required credentials. 
• Create, maintain, and attest CAQH profiles, upload required documentation, and authorize payer access as necessary. 
• Administer provider enrollment and ongoing participation with commercial insurance carriers, Medicare, Medicaid, managed Medicaid plans, and other assigned payers. 
• Manage provider lifecycle updates, including new enrollments, terminations, demographic changes, ownership transitions, tax identification updates, and practice location changes. 
• Ensure compliance with payer-specific enrollment requirements and maintain all required documentation for commercial and government health plans. 
• Maintain Illinois Medicaid enrollment through the iMPACT system or other applicable state enrollment platforms. 
• Manage the credentialing database and related software systems by entering, validating, and maintaining provider information, enrollment status, credentialing milestones, expiration dates, payer communications, and supporting documentation to ensure data accuracy, regulatory compliance, and timely reporting. 
• Track credentialing applications, document payer correspondence, monitor approval timelines, and identify outstanding requirements to ensure timely completion. 
• Proactively communicate with insurance payers to obtain status updates, resolve issues, and keep credentialing applications moving through the approval process. 
• Provide regular updates on credentialing progress, milestones, risks, and potential delays to leadership and other key stakeholders. 
• Present credentialing status, trends, key metrics, and insights to internal stakeholders and external partners to support informed decision-making. 
• Build and maintain strong working relationships among Business Development support teams, practice leadership, office staff, Human Resources, Revenue Cycle, Operations, and insurance payers to promote efficient credentialing workflows. 
• Collaborate cross-functionally to ensure providers are credentialed, enrolled, and participating with payers in alignment with organizational onboarding timelines. 
• Develop, implement, and maintain standard operating procedures (SOPs), process documentation, and workflow guidelines for the credentialing department to promote consistency, regulatory compliance, operational efficiency, and continuous process improvement. 
• Stay informed of evolving credentialing regulations, payer requirements, and developments within the dental industry to ensure ongoing compliance and adherence to best practices. 
• Identify opportunities to enhance credentialing workflows, improve turnaround times, streamline provider enrollment processes, leverage technology, and support the organization's continued growth and operational excellence. 

Requirements

• High school diploma or equivalent. 
• At least 2 years of healthcare credentialing, provider enrollment, or payer enrollment experience. 
• Experience with practice management and provider enrollment systems 
• Ability to manage deadlines, documentation, follow-up, and multiple payer applications at once. 
• Strong written and verbal communication skills. 
• Proficiency with Microsoft Office, including Excel, Word, and Outlook. 
• Previous Team Lead experience required

Preferred Qualifications 

• Associate’s or bachelor’s degree in healthcare administration, Business Administration, or a related field. 
• Experience in multi-location healthcare practices, specialty practices, or a healthcare services organization. 
• Experience with Illinois Medicaid iMPACT, CAQH, payer portals, EFT/ERA enrollment, and insurance contract management. 

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