Provider Administration Specialist

Job Description : REMOTE -With in 40 miles of Alpharetta, GA or Upper Allen Township, PA (Shift will be 8-5 EST)

Seeking someone with some credentialing experience.

This position is responsible for maintaining the integrity of provider information on enterprise systems including overseeing the distribution of updated information requested by dental offices. Other responsibilities include assisting in nurturing positive relationships between the health plan, providers and practice managers.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Maintains the integrity of an electronic database and assists dental providers offices with business name changes, tax ID changes, termination of dental contracts, change of ownership, business splits, sale of practices, adding additional associates, license changes, dental specialty changes, updated contract information, and provider directory assistance.
• Plan, prioritize, organize and complete work to meet established objectives.
• Work individually or with a team to solve complex problems related to provider servicing.
• Sometimes acts as a technical resource to others in own function.
• Works various workflow queues for claims where address tax identification number conflicts with the provider file data.
• Handles escalated calls from client groups as well as outgoing calls to dental offices.
• Resolves 1099 tax discrepancies with provider offices; verifying with external databases.
• Runs queries; generates monthly reports and credentialing document verification requests.
• Screens provider enrollment packets for missing information and requests missing information from the provider.
• Performs other miscellaneous duties as assigned

CORE COMPETENCIES / KNOWLEDGE & SKILL REQUIREMENTS

EDUCATION, EXPERIENCE & TRAINING REQUIRED

COMMUNICATION & INTERPERSONAL SKILLS

Written :

Verbal :

Interpersonal :

bility to pass Background and Drug Screen if Required by Client.

Medical, dental, vision, ancillary coverage and 401k benefits are available.