Top 1 Provider enrollment specialist Jobs in Providence, Ri

Provider Relations & Credentialing Specialist
Plum Dental Group —North Kingstown, RI
- Full-time
- Hybrid work
- Mid-level
- Office
- Organizational skills
- Health savings account
- Disability insurance
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12d

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Credentialing Specialist
Integrated Services for Behavioral Health —Columbus, OH
A valid driver's license and the ability to operate a motor vehicle is required. A bachelor’s degree in accounting, credentialing, or a related field is…
$23.85 - $28.02 an hour
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Provider Relations & Credentialing Specialist

Plum Dental Group -
North Kingstown, RI

Quick Apply

Job Details

Full-time
12 days ago

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Paid time off
401(k) matching
Life insurance

Qualifications

Document compliance management
Confidential information handling
Expiration dates monitoring
Provider database maintenance for medical credentialing
Overseeing healthcare denial management
Provider enrollment for medical credentialing
Practice management software
Mid-level
Medical billing discrepancy resolution
Compliance documentation
Organizational skills
Healthcare provider information
Insurance provider collaboration
Root cause analysis
Red flag analysis
Cross-functional collaboration
Medical claim denial management
Cross-functional communication
File organization
Medical billing insurance follow-up

Full Job Description

Job Title: Provider Relations & Credentialing Specialist
Department: Centralized Billing / Revenue Cycle Management
Reports To: Director of Revenue Cycle Management
FLSA Status: Non-Exempt
Location: Wickford, RI (on-site for first 90 days; hybrid eligible after)

Position Summary

The Provider Relations & Credentialing Specialist is responsible for owning the full credentialing and recredentialing lifecycle for our provider network across a 30+ location dental group operating in Rhode Island and Connecticut. This role keeps carrier relationships running smoothly and acts as a connective thread between our practices, our providers, and our billing team. As the primary point of contact for credentialing matters, the Provider Relations & Credentialing Specialist ensures no provider is ever left un-credentialed with a payer, that licenses and DEA certificates never lapse unnoticed, and that practices know exactly who to call when a billing issue is tied to credentialing. This role plays a critical part in keeping the provider network compliant, reducing claim delays and denials, and creating a seamless connection between practices, providers, and the centralized billing team.

Key Responsibilities

Credentialing & Recredentialing

Manage initial credentialing and ongoing recredentialing for all providers across every carrier we work with

Track expiration timelines and submit renewals proactively, before they become a problem

Serve as the primary point of contact with carriers to resolve credentialing issues, delays, and denials tied to credentialing gaps

Document & Compliance Management

Maintain a complete, current file for every provider: state licenses, DEA registrations, malpractice insurance, board certifications, CVs, and any other required credentialing documents

Build and maintain a tracking system that flags upcoming expirations with enough lead time to act

Ensure documentation meets each carrier's specific and often differing requirements

Provider & Practice Relations

Communicate directly and regularly with doctors and practice teams on credentialing status, document requests, and carrier updates

Act as a liaison who checks in with practices to surface billing frustrations and pain points, particularly where credentialing is the root cause

Translate what you hear in the field back to the billing team so recurring issues actually get fixed, not just patched

Cross-Functional Coordination

Work closely with the centralized billing team to identify and resolve claim denials or delays caused by credentialing status

Flag patterns across locations — if three practices are hitting the same carrier snag, that's a signal worth escalating, not three separate tickets

Qualifications

Experience with provider credentialing and payer enrollment (dental, medical, or behavioral health background all considered)

Strong organizational skills. You'll be tracking documents and deadlines across 30+ locations and dozens of providers, so nothing can fall through the cracks

Comfortable with technology and willing to learn our systems, including CareStack

Confident, friendly communicator, you'll be on the phone and in email with doctors, office managers, and carrier reps regularly

Ability to work independently, prioritize a high volume of moving deadlines, and follow through without being chased

Discretion with sensitive provider and business information

Nice to have

Prior experience with CareStack or another dental/medical practice management platform

Familiarity with CAQH, NPI/PECOS, and state-specific licensing boards in RI and CT

Compensation & Benefits

Full-time position based in the Wickford, RI office.
On-site for the first 90 days to build relationships with the team and get up to speed on systems and the provider network.
Hybrid schedule available after the 90-day onboarding period, subject to performance and business needs.
Opportunity to build and own a centralized credentialing system for a growing, multi-location dental organization — one designed so that as locations are added, the structure doesn't need to change, only the volume does.
Medical coverage with HSA or FSA options
Dental plan options
Life insurance
Short- and long-term disability
401(k) with company match
Paid time off
Company-sponsored continuing education
Opportunities for additional bonuses and incentive pay

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Provider Relations & Credentialing Specialist

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