Credentialing Specialist

SGA Dental Partners is hiring a Credentialing Specialist . This role is responsible for managing the end-to-end credentialing and recredentialing process for dental providers, ensuring accurate records, compliance with dental plan and regulatory requirements, timely application processing, and ongoing maintenance of provider data and documentation systems.

• Key Roles and Responsibilities
• Manage end-to-end credentialing and recredentialing of dentists/providers, including applications, follow-ups, and timely completion of all requirements
• Maintain accurate, up-to-date provider and office records across credentialing databases, systems, and network participation listings
• Track and manage expirations for licenses, certifications, and required documents; ensure timely renewals and compliance
• Maintain and organize all credentialing documentation, including state licenses, certifications, and supporting materials
• Monitor credentialing timelines and proactively communicate status updates to offices, providers, and management
• Manage recredentialing communications, including tracking and responding to incoming requests and managing any discrepancy resolutions
• 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 impacting 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 strict confidentiality of provider and patient information and ensure full compliance with HIPAA regulations
• Support continuous quality improvement initiatives and adhere to company policies and procedures
• Perform additional administrative or operational duties as assigned
• Knowledge/Skills/Abilities

Knowledge of English composition, grammar, spelling and punctuation.

Skilled in the use of basic office equipment such as: telephones, calculators, copier, fax, computers and computer software (MS Excel, Word, Practice Management software).

Proficient in Microsoft Excel

Ability to be professional and maintain composure when dealing with stressful situations.

Ability to cooperatively work with the doctors, co-workers, various facilities, and patients and build relationships of trust.

Maintain confidence with the patient regarding doctors and staff.

Ability to prioritize, organize and complete tasks timely.

Ability to accept constructive criticism.

Ability to understand and follow written and verbal instructions.

Ability to collect data, establish facts and maintain confidentiality.

Ability to communicate and express thoughts and ideas clearly and competently.

Ability to quickly grasp relevant concepts regarding duties and responsibilities.

Treat patients, co-workers, and doctors professionally and courteously.

• Education/ Experience
• Associate Degree preferred
• 1-3 years of medical/dental credentialing experience ideal

Strong understanding of insurance payor processes, credentialing standards, and provider data management preferred.