Dental Credentialing Manager: Medicaid & Network Enrollment

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

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