Credentialing Specialist

SGA Dental Partners•Claxton, GA

23h

About The Position

SGA Dental Partners is hiring a Credentialing Specialist to manage the end-to-end credentialing and recredentialing process for dental providers. The role ensures accurate provider records, compliance with dental plan and regulatory requirements, timely application processing, and ongoing maintenance of provider data and documentation systems. The position also provides administrative support for credentialing, network participation, and specialty service operations. It involves working with providers, offices, management, dental plans, and other relevant entities while maintaining strict confidentiality of provider and patient information and complying with HIPAA requirements.

Requirements

Knowledge of English composition, grammar, spelling, and punctuation.
Proficiency in Microsoft Excel.
Ability to use basic office equipment and software, including telephones, calculators, copiers, fax machines, computers, MS Excel, Word, and practice management software.
Ability to remain professional and composed in stressful situations.
Ability to work cooperatively with doctors, coworkers, facilities, and patients and build relationships of trust.
Ability to prioritize, organize, and complete tasks in a timely manner.
Ability to accept constructive criticism and follow written and verbal instructions.
Ability to collect data, establish facts, and maintain confidentiality.
Clear and competent communication skills.
Ability to quickly grasp concepts relevant to job duties and responsibilities.
Ability to treat patients, coworkers, and doctors professionally and courteously.

Nice To Haves

Associate degree preferred.
1–3 years of medical or dental credentialing experience is ideal.
Strong understanding of insurance payor processes, credentialing standards, and provider data management preferred.

Responsibilities

Manage end-to-end credentialing and recredentialing for dentists and other providers, including applications, follow-ups, and completion of requirements.
Maintain accurate, current provider and office records in credentialing databases, systems, and network participation listings.
Track expirations of licenses, certifications, and required documents, and ensure timely renewals and compliance.
Maintain and organize credentialing documentation, including state licenses, certifications, and supporting materials.
Monitor credentialing timelines and communicate status updates to offices, providers, and management.
Manage recredentialing communications, track and respond to incoming requests, and resolve discrepancies.
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 affecting credentialing.
Provide administrative support for credentialing, network participation, and specialty service operations.
Resolve inquiries and insurance plan discrepancies related to credentialing and provider status.
Maintain confidentiality of provider and patient information and comply with HIPAA regulations.
Support continuous quality improvement initiatives and follow company policies and procedures.
Perform additional administrative or operational duties as assigned.