Provider Relations & Credentialing Specialist
About The Position
The Provider Relations & Credentialing Specialist is responsible for owning the full credentialing and recredentialing lifecycle for our provider network across a 30+ location dental group operating in Rhode Island and Connecticut. This role keeps carrier relationships running smoothly and acts as a connective thread between our practices, our providers, and our billing team. As the primary point of contact for credentialing matters, the Provider Relations & Credentialing Specialist ensures no provider is ever left un-credentialed with a payer, that licenses and DEA certificates never lapse unnoticed, and that practices know exactly who to call when a billing issue is tied to credentialing. This role plays a critical part in keeping the provider network compliant, reducing claim delays and denials, and creating a seamless connection between practices, providers, and the centralized billing team.
Requirements
- Experience with provider credentialing and payer enrollment (dental, medical, or behavioral health background all considered)
- Strong organizational skills. You'll be tracking documents and deadlines across 30+ locations and dozens of providers, so nothing can fall through the cracks
- Comfortable with technology and willing to learn our systems, including CareStack
- Confident, friendly communicator, you'll be on the phone and in email with doctors, office managers, and carrier reps regularly
- Ability to work independently, prioritize a high volume of moving deadlines, and follow through without being chased
- Discretion with sensitive provider and business information
Nice To Haves
- Prior experience with CareStack or another dental/medical practice management platform
- Familiarity with CAQH, NPI/PECOS, and state-specific licensing boards in RI and CT
Responsibilities
- Manage initial credentialing and ongoing recredentialing for all providers across every carrier we work with
- Track expiration timelines and submit renewals proactively, before they become a problem
- Serve as the primary point of contact with carriers to resolve credentialing issues, delays, and denials tied to credentialing gaps
- Maintain a complete, current file for every provider: state licenses, DEA registrations, malpractice insurance, board certifications, CVs, and any other required credentialing documents
- Build and maintain a tracking system that flags upcoming expirations with enough lead time to act
- Ensure documentation meets each carrier's specific and often differing requirements
- Communicate directly and regularly with doctors and practice teams on credentialing status, document requests, and carrier updates
- Act as a liaison who checks in with practices to surface billing frustrations and pain points, particularly where credentialing is the root cause
- Translate what you hear in the field back to the billing team so recurring issues actually get fixed, not just patched
- Work closely with the centralized billing team to identify and resolve claim denials or delays caused by credentialing status
- Flag patterns across locations — if three practices are hitting the same carrier snag, that's a signal worth escalating, not three separate tickets
Benefits
- Medical coverage with HSA or FSA options
- Dental plan options
- Life insurance
- Short- and long-term disability
- 401(k) with company match
- Paid time off
- Company-sponsored continuing education
- Opportunities for additional bonuses and incentive pay
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
