Provider Enrollment Credentialing Specialist

Primary responsibilities include taking a new provider application from receipt to inclusion on directory along with ongoing updates. This includes accurate and timely entry of provider data including provider applications and contract information, status changes, payee changes, verifying all the credentialing criteria for practitioners that have applied to the network, including both initial and re-credentialing and follow up with practitioners as needed to obtain information for the credentialing process or as a result of mail being returned undeliverable to DentaQuest.

JOB DUTIES AND RESPONSIBILITIES :

• Enter and maintain Provider applications, contracts and updates into the system.
• Enter and maintain all Provider information into credentialing database.
• Verify potential and existing Provider's licensure, liability insurance, BNDD, CDS and DEA certificate.
• Verify Provider's education, hospital privileges, Board certification and other criteria as required.
• Verify accurate banking & billing information.
• Perform ongoing research tocorrect data so it does not create duplicate provider, locations, payees, and participations.
• Maintain credentialing information by reviewing, entering and following up on missing information.
• Review National Practitioners Data Bank for adverse charges pending or filed against Provider.
• Track contract applications status.
• Assure all files have a Welcome, Denial or Term Letter as appropriate.
• Meet required turnaround times and accuracy rates.
• Maintain fee schedules by creating, reviewing and auditing provider fees.
• Keep up to date provider enrollment process and records and track provider participation levels.
• Facilitate provider related research based on suspended claims, PO returns and other feedback opportunities.
• Participation in credentialing committee as necessary.
• Update the system and the credentialing database to reflect approvals, denials and / or terminations.
• Assist with other duties as assigned.

Skills & Requirements

JOB REQUIREMENTS :

Careers

As one of the nation's leading oral health companies, we direct all our energy and resources to improving oral health in the communities we serve. We depend on our people for our ability to provide the highest-quality benefit programs and superior customer service. If you're looking for a challenging work environment where you will be asked to continually develop your skills, you've found the right place.

We are a growing, financially sound company with many advantages to offer to our employees. In addition to competitive salaries and a great benefits package, we also offer a stimulating, productive work environment. Work-life balance is a reality at DentaQuest, as is our commitment to our employees' career advancement.

DentaQuest is an equal opportunity employer. We believe that your work history is the best measure of the value you will bring to the company. We do not base any employment decision on a person's race, religion, color, national origin, gender, sexual preference, marital status, age, veteran status, or disability unrelated to the ability to do the job.

Thank you for visiting. We are delighted that you are considering joining our team of dedicated oral health professionals.