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Job Details

Credentialing Specialist

Company name
DentalOne Partners

Location
Plano, TX

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Job Description
Default: Practice : Practice\r\r\r\r\r\r\r\r\r\rPlano Corporate Office\r\r\r\r\r\r\r\r\r\r\r\r\r\rOverview\r\r\r\r\r\r\r\r\r\rPurpose:  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.\r\r\r\r\r\r\r\r\r\r\r\r\r\rResponsibilities\r\r\r\r\r\r\r\r\r\rEnsure accurate and timely processing of supported dentist hires, transfers and terminations for the purposes of credentialing, data analysis and provider directory managementCoordinate the completion and submission of all required credentialing applications between the supported dentist and payerManage and support data management processes to track and report credentialing and payer‐related dataCreation 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 departmentsPartner with centralized departments to troubleshoot out‐of‐network payer issues and other payer‐related discrepancies as neededCultivate and maintain relationships with payer points of contact to resolve discrepancies in an expedited mannerAid in process improvement opportunities to optimize departmental processes and achieve maximized efficiencyResearch, gather and organize data as needed, to support the preparation of fee schedule maintenance and other payer‐related information as neededManage electronic claims enrollment and enroll new providers as needed, through third party vendorParticipate 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 mannerAdhere to all company policies and procedures, including any applicable State or Federal regulationsParticipate in department meetings and activities as requiredComplete special projects and other job duties as directed\r\r\r\r\r\r\r\r\r\r\r\r\r\rQualifications\r\r\r\r\r\r\r\r\r\rExperience/Skills/Abilities:Associates / Bachelor’s Degree in Business or Healthcare Administration preferred2 years delegated Credentialing experience requiredHigh volume phone calls/call center experience preferredDental insurance experience preferred but not requiredAccounts receivable experience preferred but not requiredComputer literate with MS Office Suite experienceStrong and effective verbal and written communication skillsEffective problem‐solving and thorough critical thinking skillsExcellent organization and follow‐up skillsHigh degree of professionalism and professional imageEnergetic interpersonal and relationship building skillsMaintain and support a culture of compliance, ethics and integrityAbility to work in a fast paced environmentStrong initiative and able to exercise sound judgment within the workplacePositive attitude, change advocate, and a leader by exampleWork environment/Conditions:Overtime as needed to perform job dutiesTravel 10% as needed

Company info

DentalOne Partners

Company Profile

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