Credentialing Specialist


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Overview:

Purpose:  The delegated Credentialing Specialist contributes to the overall success of the department by strengthening relationships with DentalOne Partners corporate departments, insurance payers, and supported dental practices and dentists, meeting department service level agreements and executing annual strategic plans. This position will support all comprehensive processes for credentialing and re‐credentialing, both new and existing supported dentists and dental practices located across three regions.


Responsibilities:

  • Ensure accurate and timely processing of supported dentist hires, transfers and terminations for the purposes of credentialing, data analysis and provider directory management
  • Coordinate the completion and submission of all required credentialing applications between the supported dentist and payer
  • Manage and support data management processes to track and report credentialing and payer‐related data
  • Creation and maintenance of provider files, the completion of credentialing applications and contracts, the gathering and verification multiple documents all within department standard operations procedures and service level agreements.
  • Conduct research into insurance payers, gathering and organizing data, participating in the organization and maintenance of fee schedules, and other administrative functions as directed.
  • Act as a liaison between the supported dental practices, field operations and centralized departments
  • Partner with centralized departments to troubleshoot out‐of‐network payer issues and other payer‐related discrepancies as needed
  • Cultivate and maintain relationships with payer points of contact to resolve discrepancies in an expedited manner
  • Aid in process improvement opportunities to optimize departmental processes and achieve maximized efficiency
  • Research, gather and organize data as needed, to support the preparation of fee schedule maintenance and other payer‐related information as needed
  • Manage electronic claims enrollment and enroll new providers as needed, through third party vendor
  • Participate in the creation and maintenance of shared information in electronic folders, emails and on Dental Bytes (intranet)
  • Process all W‐9, 1099, 147C letters or any requests for information, in a timely manner
  • Adhere to all company policies and procedures, including any applicable State or Federal regulations
  • Participate in department meetings and activities as required
  • Complete special projects and other job duties as directed

Qualifications:

 

Experience/Skills/Abilities:

  • Associates / Bachelor’s Degree in Business or Healthcare Administration preferred
  • 2+ years delegated Credentialing experience required
  • High volume phone calls/call center experience preferred
  • Dental insurance experience preferred but not required
  • Accounts receivable experience preferred but not required
  • Computer literate with MS Office Suite experience
  • Strong and effective verbal and written communication skills
  • Effective problem‐solving and thorough critical thinking skills
  • Excellent organization and follow‐up skills
  • High degree of professionalism and professional image
  • Energetic interpersonal and relationship building skills
  • Maintain and support a culture of compliance, ethics and integrity
  • Ability to work in a fast paced environment
  • Strong initiative and able to exercise sound judgment within the workplace
  • Positive attitude, change advocate, and a leader by example

Work environment/Conditions:

  • Overtime as needed to perform job duties
  • Travel 10% as needed

 




2020-14221
Credentialing Specialist
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