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Provider Enrollment and Credentialing Coordinator

2 months ago

Grafton, Wisconsin, United States DentaQuest Full time

Position Overview:
As a vital member of the DentaQuest team, the Provider Enrollment Credentialing Specialist is responsible for managing the lifecycle of provider applications, ensuring their accurate entry and ongoing updates in our systems. This role is crucial for maintaining the integrity of our provider network and ensuring compliance with credentialing standards.

Key Responsibilities:

  • Process and maintain provider applications, contracts, and updates in the database.
  • Ensure accurate entry of all provider information into the credentialing system.
  • Conduct thorough verification of provider credentials, including licensure, insurance, and certifications.
  • Assess educational background, hospital privileges, and board certifications as necessary.
  • Confirm banking and billing details for accuracy.
  • Engage in ongoing data integrity research to prevent duplication of provider records.
  • Maintain up-to-date credentialing files by tracking and following up on missing information.
  • Review the National Practitioner Data Bank for any adverse actions against providers.
  • Monitor the status of contract applications and ensure timely processing.
  • Ensure all files are complete with appropriate documentation, including welcome and denial letters.
  • Meet established turnaround times and maintain high accuracy rates.
  • Manage fee schedules by creating and auditing provider fees.
  • Stay informed about the provider enrollment process and track participation levels.
  • Assist in provider-related research concerning claims and feedback.
  • Participate in credentialing committee meetings as required.
  • Update the credentialing database to reflect approvals, denials, or terminations.
  • Perform additional duties as assigned.
Qualifications:

  • High School diploma or equivalent; Associate's degree preferred.
  • 1-2 years of experience in a business environment.
  • Experience in data collection and file management is advantageous.
  • Proficiency in Excel is required.
  • Familiarity with general office software (Word, Outlook) is necessary.
  • Ability to quickly learn new software applications.
  • Strong basic math skills.
  • Exceptional customer service abilities.
  • Excellent verbal and written communication skills.
  • Professional interaction skills with colleagues, clients, and providers.
  • Demonstrated ability to work independently and collaboratively.
  • Strong organizational skills with the ability to manage multiple tasks.
  • Capacity to maintain organization amidst interruptions.
  • Ability to make independent decisions.
  • Meticulous attention to detail.
  • Solid business acumen.
  • Adaptability to a dynamic work environment.
  • Willingness to work beyond standard hours when necessary.
Company Overview:

DentaQuest is committed to enhancing oral health across the communities we serve. Our dedicated team is essential to delivering high-quality benefit programs and exceptional customer service. We pride ourselves on fostering a supportive work environment that encourages professional growth and work-life balance. DentaQuest is an equal opportunity employer, valuing the diverse experiences and backgrounds of our employees.