Dental Credentialing Manager

Lone Peak Dental Group•Denver, CO

2d•Hybrid

About The Position

Lone Peak Dental Group is seeking a Dental Credentialing Manager to join their Credentialing team. This role is responsible for supporting doctors, leaders, and team members with the tools, training, and confidence they need to grow in their roles and deliver excellent care to children and families. The ideal candidate is a self-starter, solution-oriented, highly organized, and excited to help build and support credentialing experiences across the organization. This role is best suited for someone who can manage multiple moving pieces, bring structure to ideas, and turn needs into clear, practical resources while ensuring programs run smoothly behind the scenes. The position involves owning details, working in a fast-paced environment, and taking initiative to move work forward.

Requirements

Bachelor's degree in healthcare administration, business, or a related field, or equivalent relevant experience.
At least five years of progressive credentialing, provider enrollment, payer relations, or network management experience.
At least three years of leadership or direct staff-management experience.
Significant credentialing experience within a dental service organization, multi-location dental group, or comparable multi-unit healthcare environment.
Extensive experience with dental Medicaid enrollment, revalidation, managed Medicaid plans, and state-specific provider enrollment requirements.
Demonstrated experience managing delegated credentialing programs and payer audits.
Experience negotiating with payers, provider relations representatives, government agencies, and/or healthcare providers.
Strong knowledge of CAQH, NPPES, Medicaid enrollment portals, payer portals, primary-source verification, sanctions monitoring, and provider data management.

Responsibilities

Lead all credentialing, recredentialing, provider enrollment, delegated credentialing, and payer participation activities across a multi-location dental organization.
Lead, coach, and develop a team of credentialing and provider enrollment specialists.
Oversee initial credentialing, recredentialing, provider enrollment, revalidation, and demographic maintenance for dental providers and locations.
Serve as the organization's subject-matter expert for dental Medicaid credentialing and enrollment.
Manage provider and group enrollment across multiple state Medicaid programs and Medicaid managed care organizations.
Oversee revalidations, ownership and control disclosures, fingerprinting or screening requirements, site visits, affiliation requests, and changes of information.
Lead and administer delegated credentialing programs with contracted payers.
Ensure credentialing and recredentialing activities comply with delegation agreements, payer policies, applicable regulatory standards, and internal policies.
Maintain complete and compliant credentialing files, committee documentation, policies, procedures, reports, and quality-control records.
Serve as an escalation point for payer enrollment, participation, and contracting issues.
Negotiate or support negotiations related to network participation, provider effective dates, closed panels, retroactive enrollment, reimbursement arrangements, and contract exceptions.
Lead credentialing activities associated with new office openings, acquisitions, mergers, provider transitions, and market expansion.
Develop dashboards and reports for application status, aging, provider readiness, recredentialing, expirables, audit compliance, and staff productivity.
Monitor key performance indicators and identify bottlenecks, recurring payer issues, and opportunities for automation.
Perform routine quality audits of credentialing files and enrollment records.