Credentialing Specialist

Full-time

Credentialing Specialist

Position Type:
Full-Time | In-Person (On-Site)

This is an in-person position and is not eligible for remote work.

We are a fast-growing Dental Support Organization (DSO) dedicated to supporting our dental providers and offices through efficient operations, strong payer relationships, and accurate insurance participation management.

We are seeking a detail-oriented, analytical, and highly motivated Credentialing Specialist to join our team. This position plays an important role in managing provider credentialing, maintaining insurance payer relationships, analyzing fee schedules, and ensuring accurate provider participation across our growing organization.

The Credentialing Specialist is responsible for coordinating and maintaining provider credentialing, insurance contracting, payer enrollment, and fee schedule management across multiple dental practices.

This role requires strong organizational skills, attention to detail, analytical thinking, and the ability to manage multiple priorities. In addition to traditional credentialing responsibilities, the specialist will assist with fee schedule analysis and maintenance, payer network research, provider onboarding, and acquisition-related credentialing activities.

The ideal candidate is comfortable working with large amounts of data, researching complex insurance questions, identifying discrepancies, and collaborating with internal departments and external payer representatives to resolve issues.

• Manage the end-to-end credentialing and recredentialing process for dental providers across multiple states and locations.
• Prepare, review, submit, and track insurance credentialing applications, provider enrollments, and location additions.
• Maintain accurate provider information, including licenses, DEA registrations, malpractice coverage, CAQH profiles, and other required documentation.
• Monitor application statuses, follow up with insurance payers, and
  ** escalate
  * * delays or discrepancies as necessary.
• Coordinate provider onboarding, location changes, and separations to ensure timely updates to payer participation and credentialing records.
• Verify provider participation, network affiliations, and effective dates to support accurate insurance billing.

• Obtain, review, analyze, and maintain dental insurance fee schedules across multiple payers, providers, locations, and states.
• Compare existing and proposed fee schedules to identify reimbursement differences, opportunities for improvement, and potential financial impact.
• Assist with Usual, Customary, and Reasonable (UCR) comparisons and reimbursement percentage analysis.
• Identify discrepancies, outdated fee schedules, missing procedure codes, and inconsistent reimbursement rates.
• Support payer fee schedule negotiations by preparing comparative analyses and reimbursement data.
• Coordinate fee schedule updates and maintain accurate documentation of contracted rates, effective dates, and payer agreements.
• Collaborate with internal teams to ensure fee schedule information is accurate and consistently maintained.

• Communicate with insurance representatives regarding credentialing, contracting, network participation, and reimbursement-related questions.
• Research payer networks, leased network relationships, and participation requirements.
• Investigate and resolve discrepancies involving provider participation, effective dates, network assignments, and contractual information.
• Maintain organized records of payer agreements, correspondence, and credentialing documentation.
• Monitor payer updates and changes that may affect provider participation or reimbursement.

• Maintain accurate credentialing and payer information within internal tracking systems and reporting dashboards.
• Utilize spreadsheets and reporting tools to analyze credentialing activity, fee schedules, and operational trends.
• Identify opportunities to improve workflow efficiency, data accuracy, and reporting processes.
• Assist with the development and maintenance of standardized credentialing procedures and documentation.
• Support internal audits and quality assurance reviews to ensure accurate and complete records.

• Work closely with Revenue Cycle Management (RCM), Operations, and office…