Credentialing Specialist

SGA Dental Partners•Claxton, GA

18d

About The Position

SGA Dental Partners is hiring a Credentialing Specialist to manage end-to-end credentialing and recredentialing 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. It also provides administrative support for credentialing, network participation, and specialty service operations while maintaining the confidentiality of provider and patient information and complying with HIPAA. The position supports continuous quality improvement and follows company policies and procedures. Additional administrative or operational duties may be assigned.

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, Microsoft Word and Excel, 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 on time.
Ability to accept constructive criticism and follow written and verbal instructions.
Ability to collect data, establish facts, and maintain confidentiality.
Ability to communicate thoughts and ideas clearly and competently.
Ability to quickly grasp concepts relevant to duties and responsibilities.
Ability to treat patients, coworkers, and doctors professionally and courteously.

Nice To Haves

Associate degree preferred.
One to three years of medical or dental credentialing experience is ideal.
Strong understanding of insurance payer 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 timely completion of requirements.
Maintain accurate, up-to-date provider and office records across credentialing databases, systems, and network participation listings.
Track expiration dates for 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 proactively 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 that affect 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 confidentiality of provider and patient information and comply with HIPAA regulations.
Support continuous quality improvement initiatives and adhere to company policies and procedures.
Perform additional administrative or operational duties as assigned.