Credentialing Services Specialist

Description

About Dean Dorton

Dean Dorton is a leading professional services firm spanning certified public accounting, business advisory, and technology solutions. We are your partners in redefining success through innovation and data-driven strategies. Our experts provide an integrated suite of audit, tax, business management, consulting and technology solutions to companies both domestic and international. We help our clients strategize, adapt, and change in every stage of business, from startup and growth to succession planning and everything in between.

About the Team

Dean Dorton’s Healthcare Consulting team partners with healthcare organizations of all sizes — from independent physician practices to multi-hospital systems — to improve financial performance, strengthen operations, and enhance patient outcomes. Our team provides comprehensive services spanning revenue cycle management, billing and credentialing, strategic planning, compliance, and performance improvement. By combining deep industry expertise with practical, data-driven solutions, we help clients navigate regulatory complexities, streamline processes, and achieve long-term financial and operational success.

About the Role

The Credentialing Services Specialist plays a vital role in ensuring that healthcare providers are accurately credentialed and enrolled with payers, enabling efficient reimbursements and uninterrupted patient care. This position manages all aspects of the credentialing process, including applications, licensure tracking, and ongoing compliance across multiple states and payer types. The ideal candidate is detail-oriented, highly organized, and committed to accuracy and confidentiality. This role is well-suited for someone who thrives in a fast-paced environment and takes pride in supporting clients through precise, compliant, and timely credentialing services.

Essential Duties & Responsibilities

The essential duties and responsibilities of the Credentialing Specialist role are outlined below in correlation with Dean Dorton’s performance management impact areas.

Technical

Definition: your specialized knowledge & expertise associated with the work you perform for/with clients (note: clients may be internal to Dean Dorton).

• Manage provider credentialing and enrollment processes with Medicare, Medicaid, and commercial payers.
• Initiate payer contracts for new physician practices and monitor revalidations and renewals.
• Maintain accurate provider records, including licensure, certifications, malpractice insurance, and DEA registration.
• Complete applications and updates in Intellisoft, CAQH, and payer-specific portals.
• Track and resolve credentialing-related issues to ensure uninterrupted claim processing and payment.
• Research and stay current on credentialing requirements and payer policy changes, sharing updates with clients and team members.
• Ensure compliance with all federal, state, and payer-specific credentialing regulations.

Behavioral

Definition: the behaviors associated with performing your job (interpersonal skills).

• Communicate proactively and professionally with clients, providers, and payer representatives.
• Manage multiple credentialing projects simultaneously while meeting deadlines and maintaining quality.
• Demonstrate discretion, professionalism, and adherence to HIPAA and confidentiality standards.
• Exhibit strong organizational and problem-solving skills in managing high volumes of detailed information.
• Collaborate effectively with internal team members to improve workflows and client satisfaction.
• Take initiative to identify process efficiencies and contribute to team success.

Non-Charge

Definition: the contribution you make to Dean Dorton outside of client work.

• Participate in internal training and development programs to maintain current knowledge of credentialing regulations and payer trends.
• Contribute to continuous improvement initiatives within the Healthcare Consulting team.
• Support internal knowledge-sharing by documenting best practices and credentialing updates.
• Assist in mentoring or cross-training new team members.
• Represent the firm’s values of integrity, collaboration, and client service in all professional interactions.

Experience & Qualifications

• Minimum of 2 years of experience in provider credentialing, preferably across multiple payers and specialties.
• Experience with Intellisoft and CAQH databases preferred.
• Familiarity with EFT setup, payer enrollment, and credentialing requirements across multiple states.
• Strong attention to detail, organization, and record-keeping skills.
• Ability to manage multiple priorities with accuracy under tight deadlines.
• Commitment to confidentiality and compliance with HIPAA regulations.
• Strong communication and customer service skills.

Software & Tools

• Intellisoft and CAQH databases
• Microsoft Office Suite (Excel, Word, Outlook, Teams)
• Payer credentialing and electronic payment systems (EFT platforms)
• Healthcare payer portals and credentialing platforms

Travel

This position requires minimal travel to Dean Dorton offices or client locations.

This job description is intended to describe the general nature and level of work being performed by team members assigned to this position. It is not intended to be an exhaustive list of all responsibilities, duties, and skills required. Additionally, responsibilities and duties may vary depending on business needs and individual circumstances. Dean Dorton is an equal opportunity employer.