Credentialing Specialist

About the Role We are seeking a detail-oriented Credentialing Specialist with 3+ years of experience to join our team. This role is responsible for managing the end-to-end credentialing and re-credentialing process for providers, ensuring compliance with regulatory, payer, and accreditation standards. The ideal candidate has strong organizational skills, a keen eye for detail, and experience navigating credentialing databases and payer enrollment systems. Key Responsibilities * Process initial credentialing and re-credentialing applications for physicians, nurse practitioners, and other healthcare providers * Verify provider credentials, including licenses, education, board certifications, malpractice history, and work history through primary source verification (PSV) * Maintain accurate and up-to-date provider files in credentialing databases MD-Staff * Coordinate with payers to complete provider enrollment and ensure timely reimbursement eligibility * Track expiring licenses, certifications, and insurance to ensure continuous compliance * Prepare credentialing files for committee review and present findings as needed * Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state/federal regulations * Respond to internal and external inquiries regarding provider credentialing status * Maintain confidentiality of sensitive provider information in accordance with HIPAA * Identify and resolve discrepancies in credentialing files in a timely manner * Support audits and provide documentation as requested Qualifications * 3+ years of credentialing experience in a healthcare, managed care, or hospital setting * Bachelor's degree preferred * Strong knowledge of credentialing standards (NCQA, URAC, CMS) and primary source verification processes * Experience with credentialing software/databases (CAQH, MD-Staff) * Familiarity with payer enrollment processes (Medicare, Medicaid, commercial insurers) * Excellent attention to detail and organizational skills * Strong written and verbal communication skills * Ability to manage multiple priorities and meet deadlines in a fast-paced environment * Proficiency in Microsoft Office (Excel, Word, Outlook) Preferred Skills * Experience with delegated credentialing audits * Knowledge of state-specific licensing requirements * Prior experience supporting medical staff committees or credentialing committees

Please Note: This position is full-time, open to remote work with travel as needed to our NY headquarters locations.   OUR POSITION:  Premier Care Dental Management is a growing dental practice management company that supports multi-state dental offices providing general dentistry and specialty services to children and adults. The Credentialing Operations Manager will report to the Vice President of Payor Relations and oversees credentialing, delegated credentialing, provider enrollment, payer participation, and scalable processes that support continued growth. This role partners with the Vice President of Payor Relations to expand delegated credentialing programs and infrastructure, while working with Revenue Cycle, Human Resources, Operations, and other teams to support provider readiness. This role is ideal for an experienced dental credentialing professional who thrives in a fast-paced environment, solves operational challenges, and builds efficient, scalable processes.  PRIMARY RESPONSIBILITIES:  * Lead, coach, and develop a team of credentialing and provider enrollment specialists. * Oversee initial credentialing, recredentialing, provider enrollment, revalidation, and demographic maintenance for providers and locations. * Partner closely with the Vice President of Payor Relations to help build and expand Dental365's delegated credentialing program, operational infrastructure, and broader strategic initiatives. * Develop, document, implement, and continuously improve credentialing workflows, standard operating procedures, and operational best practices. * Monitor key performance indicators, identify operational bottlenecks, recurring payer issues, and opportunities for automation and process improvement. * Perform routine quality audits of credentialing files, enrollment records, delegated credentialing documentation, and operational processes to ensure ongoing compliance and audit readiness. * Lead the operational implementation and ongoing administration of delegated credentialing programs with contracted payers. * Ensure credentialing and recredentialing activities comply with delegation agreements, payer policies, applicable regulatory standards, accreditation requirements, and internal policies. * Maintain complete and compliant credentialing files, committee documentation, policies, procedures, reports, and quality assurance records. * Serve as the primary operational escalation point for provider enrollment, payer participation, and credentialing issues. * Lead credentialing activities associated with provider onboarding, new office openings, acquisitions, mergers, provider transitions, and market expansion. * Maintain operational dashboards and reports related to application status, aging, provider readiness, recredentialing, expirables, audit compliance, and staff productivity. Partner with Business Intelligence and other internal teams to identify reporting enhancements that support operational decision-making. * Collaborate with Revenue Cycle Management, Integrations, Finance, Business Intelligence, Information Technology, Talent Acquisition, and other cross-functional departments to support provider readiness, delegated credentialing initiatives, and organizational growth. YOUR EXPERIENCE:  * Minimum of 4–5 years of credentialing and provider enrollment experience within a Dental Service Organization (DSO) or other multi-location dental organization. * Demonstrated experience working within a delegated credentialing environment. * Strong knowledge of provider enrollment, recredentialing, CAQH, NPPES, commercial dental payer credentialing, and provider data management. * Demonstrated leadership experience managing credentialing operations and supporting high-performing teams. * Highly organized with exceptional attention to detail. * Excellent written and verbal communication skills. * Proven ability to work independently while managing multiple competing priorities. * Demonstrated success working in a fully remote environment. * Preferred experience with any of the following: Microsoft 365, DocHub, Asana, DentalxChange, Power BI, Dental EMR (Denticon a plus!), smartsheet or other automated tracking systems OUR BENEFITS: * Flexible Health and Vision Insurance Plans: Tailored options for you and your family's well-being.  * 401(K) Retirement Plan with Matching: Secure your financial future with our employer-matched plan.  * Generous Paid-Time Off: Accrue up to 3 weeks, plus an annual "you" day for self-care.  * Exclusive In-house Dental Program: Heavily discounted services for you and your immediate family.  * Extra Perks and Fringe Benefits: Enjoy additional benefits and ongoing perks for our dedicated teams.  * Incredible work environment of skilled individuals with the opportunity for massive growth! Salary Range $80,000 - $95,000 STEP INTO A NEW ERA WITH PCDM A modern practice environment designed for superior care and comfort. We embrace cutting-edge technology in a soothing environment that goes beyond your ordinary dental practice. We’ve thought through every step in the patient’s experience to perfect our communication and care so that each visit is an eagerly anticipated event.   We’re a team that supports your success. Emphasizing health over sales, we cultivate a warm, supportive culture without the pressure of production quotas. Those motivated for growth in their career are encouraged and supported to reach their full potential.   We celebrate diversity. Our company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, sexual orientation, gender identity, or gender expression in terms of all conditions of employment. Our diversity is one of our greatest strengths, and as an Equal Opportunity Employer, we are proud to promote a work environment where all differences are respected.       Salary Range $80,000—$95,000 USD