| Location | Effingham, IL (Remote) |
Job Details Req ID: 120980 Supported Practice: Heartland Dental Category: Dental Insurance Administration Location: 1200 Network Centre Drive, Effingham, IL 62401 Salary: $20.00 per hour Position Summary: Expirations & Data Integrity Specialist, Dental Insurance Administration- RemoteHeartland Dental is looking to expand our team! The Expirations & Data Integrity Specialist serves as a subject matter expert responsible for ensuring the integrity, accuracy, regulatory compliance, and ongoing maintenance of provider credentialing data across all delegated credentialing programs. This role is responsible for monitoring provider credential expirations, conducting data governance activities, mitigating compliance risks, maintaining credentialing system accuracy, and driving continuous process improvement initiatives.The Specialist partners with internal stakeholders, supported offices, providers, payors, credentialing vendors, and compliance teams to ensure provider information remains accurate, current, and compliant with NCQA, CMS, state regulatory, delegated entity, and payor requirements.This position serves as a critical control function protecting provider participation, reimbursement, delegated credentialing compliance, and organizational readiness for audits. The position only supports dental providers, Hygienists and Dental Assistants are not included.The position reports to the Delegated Credentialing Supervisor and is a fully remote position based out of Effingham, IL.With more than 1,900+ dental offices supported across 39 states, over 20,000 team members and over 3,100 supported doctors, Heartland Dental has a proven track record of growth and success. We're looking for professional individuals who are open, positive and mentally flexible to join our network of support. Below is an overview of the duties and responsibilities you would take on in this role:Monitor and track provider credentials, including state licenses, DEA registrations, CDS/CSR permits, board certifications, malpractice insurance, BLS/ACLS/PALS certifications, sedation permits, hospital privileges, and additional regulatory requirements.Proactively notify providers and internal teams of upcoming expirations and required renewals.Evaluate credentialing documentation for completeness, accuracy, authenticity, and compliance with delegated credentialing standards. Identify and mitigate compliance risks associated with expired, lapsed, or incomplete credentialing documentation. Ensure provider records comply with NCQA, CMS, state regulatory requirements, delegated credentialing agreements, and individual payor standards. Escalate compliance concerns and credentialing risks to leadership.Perform regular data audits to identify inconsistencies, missing information, or outdated documentation.Reconcile provider data across internal systems & credentialing platforms by regularly monitoring reports and dashboards. Along with establishing and monitoring key data quality metrics and reporting standards.Provide timely and friendly customer service to our supported doctors, offices, and field operationsDevelop standard operating procedures and documentation for data governance and credential maintenance processes.Partner with Credentialing, Payor Enrollment, Compliance, DIA Operations, and IT teams to implement workflow enhancements and system improvements.Develop a comprehensive understanding of the end-to-end delegated credentialing process to build cross-functional expertise and provide support across team functions as business needs arise. Minimum Requirements:Detail-oriented with strong organizational skillsProficient in Microsoft Office and reporting systemsExcellent communication and customer service skillsStrong multitasking, prioritization, and problem-solving abilitiesSelf-motivated with good judgment and initiativeProcess improvement mindset with an interest in leveraging technology and automation to drive efficiency and growthPreferred Requirements:Advanced Microsoft Excel skills, including Pivot Tables, VLOOKUP/XLOOKUP, Power Bi, and data analysis.Experience developing and maintaining operational dashboards and reports to monitor key performance indicators, compliance metrics, workflow trends, and departmental performance.Experience working with NCQA standards, delegated credentialing requirements, provider licensing requirements, and regulatory compliance. Experience utilizing credentialing software, provider databases, and reporting tools. Physical Requirements: Ability to perform essential duties satisfactorily with or without reasonable accommodation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties of the positionProlonged periods sitting at a desk and working on a computerMust be able to lift up to 15 pounds at times We put our people first at Heartland Dental, and that shows in our generous benefits package. Company retains the sole discretion to change the duties of the position at any time. We provide all employees and applicants for employment in the protections of federal, state, and local laws affording equal opportunity in employment.