What are the responsibilities and job description for the Provider Enroll & Credentialing Support Specialist, DentaQuest position at Sun Life Financial?
You are as unique as your background, experience and point of view. Here, you'll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.
Job Description : Job Description :
Location : We support US flexible working arrangements in the contiguous 48 states.
At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you'll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.
The opportunity :
Provider Enrollment and Credentialing Specialist reviews all aspects of the Initial / Re-Apply Credentialing, Re-credentialing, privileging and overseeing the onboarding process for all incoming providers. Primary responsibilities include verifying all the credentialing criteria for practitioners that have applied to the network, including follow up with practitioners as needed to obtain information
How you will contribute :
- Verify potential and existing provider's licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification.
- Contract Validation : Review contract and application for completeness.
- Review National Practitioners Data Bank for adverse charges pending or filed against Provider.
- Review federal and / or state OIG and SAM report for exclusion from the Medicaid or Medicare program.
- Review state Medicare OPT Out report for exclusion from the Medicare program.
- Monitors and reports provider complaints and utilization management reports.
- Assist with scheduling site reviews.
- Enroll the provider into payment system - Windward.
- Enter all provider information into credentialing database - Cactus.
- Maintain the integrity of the provider information in Windward and Cactus.
- Ensures credentialing file is in order with any issues flagged for committee.
- Meet required turnaround time and accuracy rate.
- Assist with other duties as assigned.
- Assist management in the implementation of department process improvements.
- Assist with the ongoing NCQA certification activities.
- Represent DentaQuest in a professional manner at all times while communicating with internal and external requestors.
- Maintains confidentiality of the credentialing information.
- Other duties as needed or required.
What you will bring with you :
Do you see yourself in this role even if you haven't checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.
Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!
Life is brighter when you work at Sun Life
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Salary Range : $39,300 - $53,100
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.
Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com / us to learn more.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
LI-remote
Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
Job Category :
Customer Service / Operations
Posting End Date : 08 / 09 / 2025
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Salary : $39,300 - $53,100
