[Hiring] Payor Audit & Enrollment Specialist @Dental Care Alliance

Role Description

The Specialist – Payor Audit & Provider Enrollment serves as the organization's subject-matter expert for payor audit response, delegated credentialing oversight, and provider enrollment data integrity. This role manages payor-initiated audits from intake through resolution, determining response strategy and authoring formal responses on behalf of the organization; leads delegated credentialing audits and maintains continuous audit readiness against payor and accreditation standards; and governs provider enrollment and billing data within DentalXchange and connected systems.

• Serve as the organization's subject-matter expert and point of contact for payor-initiated audits arising from patient complaints, billing concerns, quality-of-care allegations, and grievances.
• Independently evaluate each audit request to determine scope, exposure, and response strategy.
• Analyze practice, billing, and clinical records to construct the factual record supporting each response.
• Negotiate response timelines and extension requests with payor audit and network management contacts.
• Analyze audit outcomes, root causes, and turnaround performance; translate findings into recommendations for provider education, workflow redesign, and policy change.
• Own the organization's delegated credentialing audit program.
• Conduct internal file audits and mock audits against NCQA/URAC-aligned and payor-specific standards.
• Draft and recommend corrective action plans in response to audit findings.
• Serve as system subject-matter expert and data owner for provider enrollment information within DentalXchange.
• Define and maintain the end-to-end enrollment workflow connecting credentialing, contracting, and clearinghouse activation.
• Design and perform recurring data integrity reviews reconciling demographic, NPI, tax ID, and enrollment data.
• Define the record-keeping standards and reconciliation cadence required to support clean claims submission.
• Build and maintain the reporting package for payor audit volume, outcomes, cycle time, delegated audit results, and enrollment data quality.
• Operate with substantial independence under general direction; set own priorities and work methods.

Qualifications

• High school diploma or equivalent required; bachelor's degree in healthcare administration, business, or a related field preferred.
• Six or more years of progressively responsible experience in dental or medical credentialing, payor enrollment, or healthcare revenue cycle.
• Direct, hands-on experience leading or materially supporting payor audits and delegated credentialing audits.
• Demonstrated experience interpreting payor contracts, delegation agreements, and NCQA/URAC-aligned credentialing standards.
• Experience in a multi-site, multi-state healthcare or DSO environment strongly preferred.
• CPCS, CPMSM, or comparable credentialing/compliance certification preferred.

Requirements

• Prolonged periods of sitting at a desk and working on a computer.
• Extensive use of a keyboard, mouse, and monitors.
• Frequent communication by telephone, video conference, and email.
• Ability to read, review, and analyze detailed documentation and data with accuracy.
• Occasionally lift or move office equipment or files weighing up to 15 pounds.

Benefits

• Full-time, remote position supporting a multi-site, multi-state practice environment.
• Collaborates virtually with Credentialing, Compliance, Billing, Revenue Cycle, and practice operations partners.
• Standard business hours apply, with occasional extended hours to meet payor-imposed audit deadlines.
• Limited travel may be required for department or organizational meetings.