Credentialing Specialist

3 weeks ago


Woodbridge, United States Lightwave Dental Full time

About the Practice:
**Job Description**:
**Responsibilities**:

- Coordinates all aspects of credentialing
- Processes request, verification, tracking on information received from credentialing sources
- Works with New Partnerships with claim-related issues due to TIN changeover
- Maintains Provider files; ensures dental licenses, DEA certificates and malpractice certificates are current at all times
- Works with RCM Manager and VP to identify and coordinate any risk management, substance abuse and/or malpractice issues. Reviews files for any "red flag" issues.
- Works with Payors for Provider Offboarding
- Obtains and audits Payor Rosters, ensuring Credentialing Master List is complete and accurate
- Conduct Provider queries with NPDB prior to joining LWD
- Ensures all Providers have an active membership with CAQH
- Maintains strict confidentiality of all Provider records and data
- Monitors and maintains provider credentialing databases; populates, updates, and maintains credentialing software and filing systems; maintains appropriate status and notes in the credentialing database.
- Interacts with various cross functional groups, complete the required auditing and reporting related to NCQA requirements for credentialing
- Obtains and maintains appropriate knowledge of company policy and procedures, state and federal regulations, guidelines, procedures, and laws required in credentialing process
- Identify process improvement opportunities that decrease costs, improve quality, and increase efficiency within the department

Qualifications:

- High School or Equivalent, college degree preferred
- 5+ years in Credentialing, preferably within a DSO
- Credentialing Software experience, required
- RCM experience, required
- Certified Provider Credentialing Specialist (CPCS), preferred
- Delegated Credentialing experience, preferred

Benefits Offered:

- In return for providing an excellent provider experience, we offer a great benefits package for full-time positions to include health and dental benefits, 401(k), holiday pay and paid time off._

Telecommute: true Travel: 25% Requisition Number: 2024-11808


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