Credentialing Specialist

About This Role

This in-person position is for a detail-oriented, analytical, and highly motivated Credentialing Specialist to manage provider credentialing, maintain insurance payer relationships, analyze fee schedules, and ensure accurate provider participation across a growing dental support organization. The role requires strong organizational skills, attention to detail, analytical thinking, and the ability to manage multiple priorities.

Responsibilities

• 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• Identify discrepancies, outdated fee schedules, missing procedure codes, and inconsistent reimbursement rates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