Credentialing Specialist
1 month ago
Company: Jefferson Dental & Orthodontics
****THIS IS NOT A REMOTE POSITION****
Responsible for all aspects of the credentialing, recredentialing and privileging processes for all dental providers who provide patient care at Jefferson Dental and Orthodontics (JDO). Responsible for ensuring providers are credentialed, appointed, and privileged with health plans. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
ESSENTIAL FUNCTIONS INCLUDE BUT ARE NOT LIMITED TO:
1. Compiles and maintains current and accurate data for all providers.
2. Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed.
3. Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
4. Maintains corporate provider contract files.
5. Maintains knowledge of current health plan and agency requirements for credentialing providers.
6. Sets up and maintains provider information in CAQH.
7. Tracks license and certification expirations for all providers to ensure timely renewals.
8. Ensures practice addresses are current with health plans, agencies and other entities.
9. Tracks license, DEA, and professional liability expirations
10. Maintains JDO appointment files, and information in credentialing database.
11. Audits health plan directories for current and accurate provider information.
ADDITIONAL RESPONSIBILITIES:
1. Maintains confidentiality of provider information.
2. Provides credentialing verifications.
3. Performs other duties as assigned.
QUALIFICATIONS:
Location: Work on-site in support center in Carrollton, Texas 75006
Education:
1. High school diploma or equivalent.
2. Associate degree preferred, but not required.
3. Certified Provider Credentialing Specialist (CPCS) preferred; a plus but not required.
Experience:
6- months - 1 year of relevant credentialing experience
Skills:
1. Knowledge and understanding of the credentialing process.
2. Ability to organize and prioritize work and manage multiple priorities.
3. Excellent verbal and written communication skills including letters, memos and emails.
4. Excellent attention to detail.
5. Ability to research and analyze data.
6. Ability to work independently with minimal supervision.
7. Ability to establish and maintain effective working relationships with providers and contacts outside the organization.
8. Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
9. Able to work on-site, this is not a remote position
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