Dental Credentialing Specialist

Position Summary:

The Dental Credentialing Specialist is responsible for managing the complete credentialing and recredentialing lifecycle for dental providers across multiple insurance payers. This includes ensuring timely submission and maintenance of provider records, monitoring application statuses, and enrolling providers and locations in Electronic Funds Transfer (EFT) programs. The role also supports new location setup by handling the creation of Type 2 National Provider Identifiers (NPI) and associated payer enrollments.

Key Responsibilities:

Credentialing & Recredentialing

• Manage initial credentialing and recredentialing applications for dental providers with commercial and government payers (e.g., PPOs, DHMOs, Medicaid, Medicare). This includes offering new providers assistance in obtaining various credentialing items (e.g. NPI enumeration, Malpractice coverage amounts, DEA enrollment)

• Maintain an organized and up-to-date credentialing database, ensuring the accuracy of provider information, licenses, and certifications.

• Track and follow up on submitted applications to ensure timely approvals and network participation.

• Respond to credentialing-related inquiries from payers and internal teams, and supply additional documentation as requested.

• Serve as primary contact for DECA’s CVO partner

New Location Setup & NPI Management

• Facilitate the creation and registration of Type 2 NPIs for new dental practice locations.

• Coordinate with operations, HR, and IT to gather necessary data for NPI submissions and ensure accurate information entry.

• Maintain documentation for all NPI records and ensure consistency across payer and internal systems.

Electronic Funds Transfer (EFT) Enrollment

• Initiate and complete EFT enrollment for providers and new locations with various payers.

• Ensure the secure collection and submission of banking information required for EFT setup.

• Confirm EFT activation and troubleshoot any issues or rejections with payers.

Compliance & Maintenance

• Ensure all credentialing and enrollment activities are compliant with NCQA, CMS, and payer-specific guidelines.

• Monitor and update records for expiring licenses, DEA certifications, malpractice insurance, and recredentialing deadlines.

• Assist with payer audits and internal credentialing reviews.

Cross-Department Collaboration

• Act as a liaison between the organization and insurance payers’ credentialing departments.

• Work closely with internal teams including Operations, HR, Revenue Cycle, and IT to coordinate provider onboarding and location setup.

• Provide regular updates and reports on credentialing, EFT enrollment, and NPI status to leadership and stakeholders.

Qualifications:

Required:

• High school diploma or equivalent.

• 2+ years of experience in healthcare or dental credentialing.

• Familiarity with CAQH, NPPES, and payer-specific credentialing portals.

• Experience in submitting and maintaining NPI records (Type 1 and Type 2).

• Working knowledge of dental insurance plans (PPO, DHMO, Medicaid, Medicare Advantage).

• Strong attention to detail and organizational skills.

• Proficiency in Microsoft Office (Excel, Outlook, Word).

Preferred:

• Experience with EFT enrollment processes and payer-specific requirements.

• Prior use of credentialing software and/or dental practice management systems such as Denticon.

• Excellent communication skills and ability to manage multiple deadlines.

Work Environment & Physical Requirements:

• Standard office environment; remote or hybrid work arrangements may be available.

• Prolonged periods of computer use.

• Occasional lifting of files or supplies up to 20 lbs.