Credentialing Specialist- Dental Process

Role & responsibilities

• Coordinate and manage the credentialing and re-credentialing process for dental providers with insurance companies, government agencies, and healthcare networks.
• Prepare, review, and submit provider credentialing applications and follow up on approvals.
• Maintain and update provider records, including licenses, certifications, malpractice insurance, and other required documents.
• Verify provider credentials through primary sources and ensure compliance with regulatory standards.
• Monitor and track credentialing renewal dates, expirations, and updates to prevent lapses in provider participation.
• Communicate with providers, payers, and internal stakeholders regarding credentialing status and required actions.
• Assist in resolving credentialing-related issues and discrepancies in a timely manner.
• Stay up to date with credentialing regulations, payer policies, and industry best practices.
• Ensure accuracy and completeness of provider data within credentialing systems and databases.

Preferred candidate profile

• Bachelors degree in healthcare administration, business, or a related field (preferred) or equivalent experience.
• Minimum of 1-2 years of experience in dental or medical credentialing.
• Knowledge of insurance and government payer requirements for provider credentialing.
• Familiarity with credentialing software and databases.
• Strong organizational skills and attention to detail.
• Excellent communication and follow-up skills.
• Ability to handle multiple tasks and meet deadlines in a fast-paced environment.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook).

• Experience working with dental insurance carriers and networks.
• Knowledge of CAQH, NPI registry, and Medicaid/Medicare credentialing requirements.

Perks and benefits