Credentialing Specialist
Employer
- Midwest Dental
Job Description
Overview
Smile Brands, a three-time Glassdoor Best Place to Work, is seeking a Credentialing Specialist to join our team! This position provides dental plan credentialing, enrollment and related support to the Operations Group by performing a board range of duties that includes completing contracting/credentialing paperwork, monitoring the contract process and reporting process, monitoring licensure, performing follow-up with plans and internal customers, completing W-9 forms, as well as completing various reports.
Essential Duties and Responsibilities
- Load provider, facility and plan information onto various databases quickly and accurately
- Update, maintain and make available the status information on databases on a daily basis
- Review plan web-sites for provider and/or facility enrollment approvals
- Serve as the liaison and maintain open communication with dental office staff, internal departments and company representatives
- Maintain library of plan information and business rules
- Take ownership of plan reporting, ensuring timeliness, completeness, accuracy and serve as the liaison to dental plans on behalf of the dental offices, obtain provider and/or facility enrollment approvals, discuss issues and process improvement
- Review, research and report on adverse provider application responses
- Monitor licensure/credentials for expiration dates, ensuring there is no lapse in licensure, by communicating with Dr.’s, Office Managers, Field reps and Management; completing all necessary follow-up
- Maintain library of Dr.’s credentials, add new Dr.’s, (GPs and Specialty) to locations within markets
- Review applications, prepare verification, update and maintain all related databases
- Create any attachments/exhibits that may be required for applications or contracts
- Process contracts/ applications with all appropriate dental plans for new and existing offices, ensuring completeness, timeliness and accuracy
- Process new Doctors credentialing - obtain and review credentials and as necessary background checks
- Continually review the credentialing and contracting processes to ensure compliance; decide if a process should be stopped and brought to the attention of Supervisor and Director before proceeding
- Research billing/contacting questions received from plans, offices and/or billing offices
- Maintain “Provider Number” spreadsheet on common drive for company reference
- Process terminations, notify dental plans of terminations and locations changes, as well as PC, DBA and TIN changes, process all necessary paperwork, initial and recredentialing
- Meet with Doctors in person (whenever necessary) and be prepared to answer all questions they may have regarding contracting/credentialing process
- Process routine re-credentialing requests to include providing current documents and current attestation statements; complete monthly access survey requests
- Complete oversight audits as required
Responsibilities
What we need from you:- 2 or more years of administrative experience in related field
- Data Entry experience
- Office Suite & Excel experience
- Pays attention to detail
- Highly motivated professional
What We’ll Offer You
- Unparalleled support to grow your career
- We are willing to train
- A culture that celebrates success and diversity
- Benefits and perks for you, your family and even your pets!
- Medical (including HSA and FSA), Dental, Vision, 401K, and paid time off for applicable full-time positions
Smile Brands Inc. and all relevant Affiliates are Equal Opportunity Employers. We are proud to celebrate diversity and provide an inclusive workplace for all employees.
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Location
Mondovi, WI
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Date Posted
551 days ago
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