Credentialing Specialist

Platinum Dental Services

. Manage the end-to-end credentialing and recredentialing process for dental providers across multiple states and locations .

Posted 10/13/2026full-timeAmerican Fork • Utah • United StatesMid-LevelSenior💰 $18 - $20 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing the credentialing and recredentialing processes for dental providers, including proficiency in analyzing insurance fee schedules and reimbursement structures. Strong organizational and communication skills are essential for coordinating with multiple stakeholders and maintaining accurate documentation.

Highest-signal resume keywords

Dental Credentialing ManagementInsurance ContractingFee Schedule AnalysisData Analysis and ReportingMicrosoft Excel Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Credentialing Process ManagementInsurance EnrollmentReimbursement AnalysisData AccuracyFee Schedule Comparison

Soft Skills

Strong Organizational SkillsAttention to DetailWritten and Verbal CommunicationProblem-Solving AbilitiesTeam Collaboration

Tools & Technologies

Microsoft ExcelGoogle SheetsOpen DentalDomoProvider Enrollment Systems

Industry Keywords

Dental InsurancePayer NetworksCredentialing DocumentationCAQHHealthcare Organization

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

Strong organizational skills with the ability to manage multiple projects, deadlines, and priorities
Excellent attention to detail and commitment to data accuracy
Strong written and verbal communication skills
Proficiency with Microsoft Excel or Google Sheets, including spreadsheets, formulas, and data comparisons
Strong research, analytical, and problem-solving abilities
Ability to work independently while collaborating with a team
Willingness to learn complex insurance processes, payer requirements, and reimbursement structures
Ability to maintain confidential information and follow applicable privacy and compliance requirements
Previous experience in dental credentialing, insurance contracting, or payer enrollment (preferred, not required)
Experience working within a Dental Support Organization or multi-location healthcare organization (preferred, not required)
Familiarity with dental insurance fee schedules, reimbursement analysis, or UCR comparisons (preferred, not required)
Experience with dental practice management software, particularly Open Dental (preferred, not required)
Familiarity with CAQH, insurance payer portals, and provider enrollment systems (preferred, not required)
Experience with data analysis, reporting dashboards, or business intelligence tools such as Domo (preferred, not required)
Understanding of dental insurance networks, leased networks, and payer participation requirements (preferred, not required)

Benefits

Comp & perks

Opportunity to work in a collaborative and growing organization
Opportunities to expand skills in credentialing, payer contracting, fee schedule analysis, and healthcare operations
Professional growth through provider support, reimbursement processes, and workflow improvement experience