Credentialing Specialist

SGA Dental Partners; Georgia; Remote; USD 52,000 - 72,000; Full time

Benefits offered by this job

Paid holidays & PTO

401(k) retirement plan

Health & Vision Insurance

Dental Insurance (employer-paid)

Life Insurance

Care.com Membership & EAP

Disability & Critical Illness coverage

Career growth opportunities

Job summary

SGA Dental Partners is seeking a Credentialing Specialist to oversee end-to-end credentialing and recredentialing for dental providers. You will maintain accurate provider records, monitor licenses and certifications, and ensure timely submissions across networks and plans.

The role requires attention to detail, strong organization, and collaboration with offices and management. Remote options are available for this role across multiple states, including Georgia.

Qualifications

• Strong understanding of credentialing processes and HIPAA requirements.
• Ability to maintain accurate provider records and communicate timelines.
• Experience with payor requirements and network participation preferred.

Responsibilities

• Manage end-to-end credentialing and recredentialing of providers.
• Maintain provider records across credentialing databases and systems.
• Track expirations for licenses and certifications and ensure renewals.
• Communicate status updates to offices, providers, and management.
• Handle inquiries and discrepancies related to credentialing and status.
• Support confidentiality and HIPAA compliance in all activities.

Skills

Attention to detail

Professional communication

Prioritization

Team collaboration

Education

Associate Degree

Tools

MS Excel

Word

Practice Management software

Job description

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 ResponsibilitiesManage end-to-end credentialing and recredentialing of dentists/providers, including applications, follow-ups, and timely completion of all requirementsMaintain accurate, up-to-date provider and office records across credentialing databases, systems, and network participation listingsTrack and manage expirations for licenses, certifications, and required documents; ensure timely renewals and complianceMaintain and organize all credentialing documentation, including state licenses, certifications, and supporting materialsMonitor credentialing timelines and proactively communicate status updates to offices, providers, and managementManage recredentialing communications, including tracking and responding to incoming requests and managing any discrepancy resolutionsEnsure provider demographic, billing, and practice information is accurate and current with dental plans and relevant entitiesStay current on dental plan requirements, regulatory standards, and industry trends impacting credentialingProvide administrative support for credentialing, network participation, and specialty service operationsResolve incoming inquiries and insurance plan discrepancies related to credentialing and provider statusMaintain strict confidentiality of provider and patient information and ensure full compliance with HIPAA regulationsSupport continuous quality improvement initiatives and adhere to company policies and proceduresPerform additional administrative or operational duties as assignedKnowledge/Skills/AbilitiesKnowledge 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 ExcelAbility 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/ ExperienceAssociate Degree preferred1-3 years of medical/dental credentialing experience idealStrong understanding of insurance payor processes, credentialing standards, and provider data management preferred.Benefits We Offer:Paid Holidays and Paid Time Off (PTO)401(k) Retirement PlanHealth and Vision InsuranceEmployer-Paid Dental Insurance, Life Insurance, Care.com Membership & Employee Assistance ProgramSupplemental Coverage (Disability, Critical Illness, Accident)Career Growth and Development OpportunitiesThis position is eligible for remote work in the following states: Alabama, Arizona, California, Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Mexico, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin.In hometown communities, SGA Dental Partners is a beacon of positive energy, delivering the highest level of clinical excellence and patient-centered care. Apply today to join us in making a difference!In order to maintain a high level of clinical excellence, SGA Dental Partners and dental practices affiliated with SGA maintain a drug free and alcohol free workplace. All new hires are required to pass a full panel drug screening as a condition of employment.SGA Dental Partners is an Equal Opportunity Employer and values diversity at every level of our team. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.