Credentialing Specialist

Platinum Dental Services•American Fork, UT

20d•$18 - $20•Onsite

About The Position

Platinum Dental Services is seeking a detail-oriented, analytical, and highly motivated Credentialing Specialist to support dental providers and offices through efficient operations, payer relationships, and accurate insurance participation management. This in-person role coordinates and maintains provider credentialing, insurance contracting, payer enrollment, and fee schedule management across multiple dental practices, states, and locations. The specialist also supports payer network research, provider onboarding, and credentialing activities related to acquisitions. The role involves working with large amounts of data, researching complex insurance questions, identifying discrepancies, and collaborating with internal departments and external payer representatives. The position supports provider participation and reimbursement accuracy while helping improve credentialing workflows, data quality, and reporting.

Requirements

Strong organizational skills and 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 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.

Nice To Haves

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.

Responsibilities

Manage end-to-end credentialing and recredentialing for dental providers across multiple states and locations.
Prepare, review, submit, and track insurance credentialing applications, provider enrollments, and location additions.
Maintain provider information and documentation, including licenses, DEA registrations, malpractice coverage, and CAQH profiles.
Monitor application statuses, follow up with payers, and escalate delays or discrepancies.
Coordinate provider onboarding, location changes, and separations, updating 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 payers, providers, locations, and states.
Compare existing and proposed fee schedules to identify reimbursement differences, improvement opportunities, and potential financial impacts.
Assist with Usual, Customary, and Reasonable (UCR) comparisons and reimbursement percentage analysis.
Identify fee schedule discrepancies, outdated schedules, missing procedure codes, and inconsistent reimbursement rates.
Prepare comparative analyses and reimbursement data to support payer fee schedule negotiations.
Coordinate fee schedule updates and document contracted rates, effective dates, and payer agreements.
Collaborate with internal teams to maintain accurate and consistent fee schedule information.
Communicate with insurance representatives about credentialing, contracting, network participation, and reimbursement questions.
Research payer networks, leased network relationships, and participation requirements.
Investigate and resolve discrepancies involving provider participation, effective dates, network assignments, and contract information.
Maintain organized records of payer agreements, correspondence, and credentialing documentation.
Monitor payer updates and changes that may affect provider participation or reimbursement.
Maintain credentialing and payer information in internal tracking systems and reporting dashboards.
Use 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 in developing and maintaining standardized credentialing procedures and documentation.
Support internal audits and quality assurance reviews for accurate and complete records.
Collaborate with Revenue Cycle Management (RCM), Operations, and office leadership to resolve insurance participation and credentialing 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 stakeholders.
Provide offices with guidance and assistance regarding payer participation, insurance networks, and credentialing processes.