Dental Credentialing Manager

Lone Peak Dental Group; Denver (CO); Hybrid; USD 80,000 - 95,000; Full time

Benefits offered by this job

Hybrid work model

PTO

Benefits

Job summary

Lone Peak Dental Group in the Denver metro area is seeking a Dental Credentialing Manager who is a self-starter, highly organized, and ready to build credentialing programs across our multi-location practice. You will lead a team of credentialing specialists and own end-to-end credentialing, enrollment, and revalidation for dental providers and locations.

This hybrid role requires strong knowledge of CAQH, NPPES, Medicaid enrollment, and payer relations, with a focus on speed, accuracy, and

Qualifications

• Bachelor's degree in healthcare administration or related field, or equivalent experience.
• Minimum 5 years in credentialing, provider enrollment, or network management.
• At least 3 years of leadership or staff-management experience.
• Credentialing experience in a multi-location dental/healthcare setting.
• Extensive Medicaid enrollment and revalidation experience for dental providers.
• Experience managing delegated credentialing programs and payer audits.
• Strong negotiation skills with payers, providers, and government agencies.
• Proficiency with CAQH, NPPES, Medicaid portals, and provider data management.

Responsibilities

• Lead, coach, and develop a team of credentialing and provider enrollment specialists.
• Oversee initial credentialing, recredentialing, enrollment, revalidation, and demographic maintenance.
• Serve as SME for dental Medicaid credentialing and enrollment.
• Manage provider and group enrollment across state Medicaid programs and MCOs.
• Oversee revalidations, disclosures, fingerprinting, site visits, and changes of information.
• Lead delegated credentialing programs with contracted payers.
• Ensure compliance with all policy, regulatory, and internal standards.
• Maintain credentialing files, policies, and quality-control records.
• Escalate payer enrollment and contracting issues as needed.
• Negotiate network participation terms and effective dates.
• Lead credentialing for new offices, acquisitions, and market expansion.
• Develop dashboards and reports for status, readiness, and audits.
• Monitor KPIs and identify bottlenecks and automation opportunities.
• Perform routine quality audits of credentialing files.

Skills

Leadership

Credentialing expertise

Payer relations

CAQH knowledge

NPPES knowledge

Education

Bachelor's degree in healthcare administration

Tools

CAQH

NPPES

Medicaid enrollment portals

Job description

Hybrid Role | Denver Metro Area

Salary Range: $80,000 to $95,000, plus PTO, benefits, and more

At Lone Peak Dental Group, we believe learning should be simple, meaningful, and connected to the real work our teams do every day. On the Credentialing team we support doctors, leaders, and team members with the tools, training, and confidence they need to grow in their roles and deliver excellent care to children and families.

We are looking for a Dental Credentialing Manager who is a self-starter, solution-oriented, highly organized, and excited to help build and support credentialing experiences across our organization. This role is a great fit for someone who can manage multiple moving pieces, bring structure to ideas, and turn needs into clear, practical resources while ensuring programs run smoothly behind the scenes.

This role is best suited for someone who enjoys owning details, working in a fast‑paced environment, and taking initiative to move work forward.

What You'll Help Create & Manage

• Lead, coach, and develop a team of credentialing and provider enrollment specialists.
• Oversee initial credentialing, recredentialing, provider enrollment, revalidation, and demographic maintenance for dental providers and locations.
• Serve as the organization's subject‑matter expert for dental Medicaid credentialing and enrollment.
• Manage provider and group enrollment across multiple state Medicaid programs and Medicaid managed care organizations.
• Oversee revalidations, ownership and control disclosures, fingerprinting or screening requirements, site visits, affiliation requests, and changes of information.
• Lead and administer delegated credentialing programs with contracted payers.
• Ensure credentialing and recredentialing activities comply with delegation agreements, payer policies, applicable regulatory standards, and internal policies.
• Maintain complete and compliant credentialing files, committee documentation, policies, procedures, reports, and quality‑control records.
• Serve as an escalation point for payer enrollment, participation, and contracting issues.
• Negotiate or support negotiations related to network participation, provider effective dates, closed panels, retroactive enrollment, reimbursement arrangements, and contract exceptions.
• Lead credentialing activities associated with new office openings, acquisitions, mergers, provider transitions, and market expansion.
• Develop dashboards and reports for application status, aging, provider readiness, recredentialing, expirables, audit compliance, and staff productivity.
• Monitor key performance indicators and identify bottlenecks, recurring payer issues, and opportunities for automation.
• Perform routine quality audits of credentialing files and enrollment records.

We Are Looking For Someone Who Brings

• Bachelor's degree in healthcare administration, business, or a related field, or equivalent relevant experience.
• At least five years of progressive credentialing, provider enrollment, payer relations, or network management experience.
• At least three years of leadership or direct staff‑management experience.
• Significant credentialing experience within a dental service organization, multi‑location dental group, or comparable multi‑unit healthcare environment.
• Extensive experience with dental Medicaid enrollment, revalidation, managed Medicaid plans, and state‑specific provider enrollment requirements.
• Demonstrated experience managing delegated credentialing programs and payer audits.
• Experience negotiating with payers, provider relations representatives, government agencies, and/or healthcare providers.
• Strong knowledge of CAQH, NPPES, Medicaid enrollment portals, payer portals, primary‑source verification, sanctions monitoring, and provider data management.

Join Us

At Lone Peak Dental Group, we are building a culture where learning is ongoing, practical, and shared. We celebrate progress, learn from challenges, and believe every team member contributes to something bigger.

Apply today and help us shape learning experiences that support our teams, strengthen our practices, and make a meaningful difference for patients and families.