Credentialing and Enrollment Specialist

About the Role

The Credentialing and Enrollment Specialist reports to the Manager of Credentialing and Enrollment and will be a key member of the Revenue Support Team. This role is primarily focused on ensuring timely, accurate and efficient credentialing and re-credentialing of all Benevis and Affiliated Entities, providers, and offices with contracted Medicaid and commercial insurance payors. The ideal candidate must be a self-starter in addition to being comfortable collaborating across various departments within the organization.

Responsibilities

• Processes credentialing and re-credentialing Medicaid and Commercial applications of dentists and tracks all progression steps in the internal database.
• Meets or exceeds individual productivity metrics, quality, and timeliness standards as defined by department guidelines.
• Review provider enrollment packets for missing information; request missing information from provider; resolve discrepancies between information supplied and findings of other sources (NPDB, State Dental Boards, etc.)
• Ability to accurately build provider records and to enter relevant information into the credentialing database and other ancillary data repositories as needed.
• Ensure the provider's credentials comply with requirements of contracted payers, as well as preparing providers files for the credentialing committee according to NCQA regulations.
• Maintains up-to-date physician database, including but not limited to medical licenses, Drug Enforcement Administration certificates, professional liability insurance, provider numbers, and renewal period expiration dates.
• Researches detailed information on provider status in response to telephone or written inquiries.
• Researches and analyzes problems with enrollment packets and recommends resolutions.
• Runs queries, generates reports, and performs credentialing document verification requests.
• Reviews correspondence received and performs appropriate action to resolve.
• Troubleshoots provider-related claims issues and works to resolve for Hold Provider claims for adjudication for in-network payments.
• Other duties and special projects as assigned.

Qualifications

• A minimum of 4 years of related healthcare experience with provider enrollment preferred in a high-volume environment in dental, medical, optometry, or medical staffing industries.
• Ability to organize, perform, and track multiple tasks accurately in short timeframes; able to work quickly and accurately in a fast-paced environment while managing multiple demands; able to work both independently and collaboratively as a team player; demonstrates adaptability, analytical and problem-solving skills, and attention to detail; and transcribe accurately.
• Proficient in using the Microsoft Office software applications (Excel, Word, PowerPoint).
• Communicate effectively, both written and orally, with dentists, payers, and interdepartmentally.
• Excellent organizational/time management and project management skills and multitasking abilities.

Benefits

• Competitive compensation.
• Comprehensive Benefits Package: Medical, Dental, Vision, 401K with match, flexible spending accounts, paid time off, company holidays and much more!