Credentialing Specialist

Job Type

Full-time

Description

Credentialing Specialist
Platinum Dental Services
Position Type: Full-Time | In-Person (On-Site)
Work Arrangement: This is an in-person position and is not eligible for remote work.

About Us
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.

Job Description
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.

Key Responsibilities
Provider Credentialing & Enrollment

• 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.

Fee Schedule Analysis & Maintenance

• 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.

Insurance Payer & Network Management

• 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.

Data Management, Reporting & Process Improvement

• 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.

Cross-Department Collaboration & Acquisition Support

• Work closely with Revenue Cycle Management (RCM), Operations, and office leadership to resolve insurance participation and credentialing-related issues.
• Support credentialing transitions for newly acquired dental practices, including provider onboarding, payer enrollment, and contract coordination.
• Communicate credentialing statuses, anticipated effective dates, and outstanding requirements to appropriate stakeholders.
• Provide guidance and assistance to offices regarding payer participation, insurance networks, and credentialing processes.

Qualifications
Required Qualifications

• Strong organizational skills with the ability to manage multiple projects, deadlines, and priorities.
• Excellent attention to detail and commitment to data accuracy.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Excel or Google Sheets, including working with spreadsheets, formulas, and data comparisons.
• Strong research, analytical, and problem-solving abilities.
• Ability to work independently while collaborating with a team.
• Willingness to learn complex insurance processes, payer requirements, and reimbursement structures.
• Ability to maintain confidential information and follow applicable privacy and compliance requirements.

Preferred Qualifications (Not Required)

• Previous experience in dental credentialing, insurance contracting, or payer enrollment.
• Experience working within a Dental Support Organization (DSO) or multi-location healthcare organization.
• Familiarity with dental insurance fee schedules, reimbursement analysis, or UCR comparisons.
• Experience with dental practice management software, particularly Open Dental.
• Familiarity with CAQH, insurance payer portals, and provider enrollment systems.
• Experience with data analysis, reporting dashboards, or business intelligence tools such as Domo.
• Understanding of dental insurance networks, leased networks, and payer participation requirements.

Why Join Us?
This is an opportunity to be part of a collaborative and growing organization where Credentialing plays an important role in both provider support and financial operations.
Our team works across multiple departments to support provider onboarding, maintain accurate insurance participation, improve reimbursement processes, and develop more efficient workflows.
We value individuals who are detail-oriented, resourceful, eager to learn, and motivated to find solutions. As our organization continues to grow, this position offers opportunities to expand skills in credentialing, payer contracting, fee schedule analysis, and healthcare operations.

Salary Description

$18-$20/hour