Credentialing Specialist

Credentialing Specialist

SGA Dental Partners is hiring a Credentialing Specialist. This role is responsible for managing the end-to-end credentialing and recredentialing process for dental providers, ensuring accurate records, compliance with dental plan and regulatory requirements, timely application processing, and ongoing maintenance of provider data and documentation systems.

Key Roles and Responsibilities

• Manage end-to-end credentialing and recredentialing of dentists/providers, including applications, follow-ups, and timely completion of all requirements
• Maintain accurate, up-to-date provider and office records across credentialing databases, systems, and network participation listings
• Track and manage expirations for licenses, certifications, and required documents; ensure timely renewals and compliance
• Maintain and organize all credentialing documentation, including state licenses, certifications, and supporting materials
• Monitor credentialing timelines and proactively communicate status updates to offices, providers, and management
• Manage recredentialing communications, including tracking and responding to incoming requests and managing any discrepancy resolutions
• Ensure provider demographic, billing, and practice information is accurate and current with dental plans and relevant entities
• Stay current on dental plan requirements, regulatory standards, and industry trends impacting credentialing
• Provide administrative support for credentialing, network participation, and specialty service operations
• Resolve incoming inquiries and insurance plan discrepancies related to credentialing and provider status
• Maintain strict confidentiality of provider and patient information and ensure full compliance with HIPAA regulations
• Support continuous quality improvement initiatives and adhere to company policies and procedures
• Perform additional administrative or operational duties as assigned

Knowledge/Skills/Abilities

• Knowledge of English composition, grammar, spelling and punctuation.
• Skilled in the use of basic office equipment such as: telephones, calculators, copier, fax, computers and computer software (MS Excel, Word, Practice Management software).
• Proficient in Microsoft Excel
• Ability to be professional and maintain composure when dealing with stressful situations.
• Ability to cooperatively work with the doctors, co-workers, various facilities, and patients and build relationships of trust.
• Maintain confidence with the patient regarding doctors and staff.
• Ability to prioritize, organize and complete tasks timely.
• Ability to accept constructive criticism.
• Ability to understand and follow written and verbal instructions.
• Ability to collect data, establish facts and maintain confidentiality.
• Ability to communicate and express thoughts and ideas clearly and competently.
• Ability to quickly grasp relevant concepts regarding duties and responsibilities.
• Treat patients, co-workers, and doctors professionally and courteously.

Education/ Experience

• Associate Degree preferred
• 1-3 years of medical/dental credentialing experience ideal
• Strong understanding of insurance payor processes, credentialing standards, and provider data management preferred.

Benefits We Offer:

• Paid Holidays and Paid Time Off (PTO)
• 401(k) Retirement Plan
• Health and Vision Insurance
• Employer-Paid Dental Insurance, Life Insurance, Care.com Membership & Employee Assistance Program
• Supplemental Coverage (Disability, Critical Illness, Accident)
• Career Growth and Development Opportunities

In hometown communities, SGA Dental Partners is a beacon of positive energy, delivering the highest level of clinical excellence and patient-centered care. Apply today to join us in making a difference!

In order to maintain a high level of clinical excellence, SGA Dental Partners and dental practices affiliated with SGA maintain a drug free and alcohol free workplace. All new hires are required to pass a full panel drug screening as a condition of employment.

SGA Dental Partners is an Equal Opportunity Employer and values diversity at every level of our team. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.