Platinum Dental Services

Credentialing Specialist

• Manage the end-to-end credentialing and recredentialing process for dental providers across multiple states and locations
• Prepare, review, submit, and track insurance credentialing applications, provider enrollments, and location additions
• Maintain provider information including licenses, DEA registrations, malpractice coverage, CAQH profiles, and required documentation
• Monitor application statuses, follow up with insurance payers, and escalate delays or discrepancies
• Coordinate provider onboarding, location changes, and separations
• 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 fee schedules and analyze reimbursement differences, improvement opportunities, and financial impact
• Assist with UCR comparisons and reimbursement percentage analysis
• Identify discrepancies, outdated fee schedules, missing procedure codes, and inconsistent reimbursement rates
• Support payer fee schedule negotiations with comparative analyses and reimbursement data
• Coordinate fee schedule updates and document contracted rates, effective dates, and payer agreements
• Communicate with insurance representatives regarding 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 contractual information
• Maintain organized payer agreements, correspondence, and credentialing documentation
• 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
• Improve workflow efficiency, data accuracy, and reporting processes
• Assist with standardized credentialing procedures and documentation
• Support internal audits and quality assurance reviews
• Collaborate with Revenue Cycle Management, Operations, and office leadership
• Support credentialing transitions for newly acquired dental practices
• Communicate credentialing statuses, anticipated effective dates, and outstanding requirements
• Guide offices regarding payer participation, insurance networks, and credentialing processes

Explore Credentialing Specialist at Platinum Dental Services. Review requirements and application details.