Provider Enrollment Credentialing Specialist

4 weeks ago

Grafton, Wisconsin, United States DentaQuest Full time
Job Summary

We are seeking a highly skilled Credentialing and Provider Enrollment Specialist to join our team at DentaQuest. As a key member of our oral health company, you will be responsible for ensuring the accurate and timely enrollment of providers into our network.

Key Responsibilities
  • Enter and maintain provider applications, contracts, and updates into our system.
  • Verify potential and existing providers' licensure, liability insurance, and other credentialing criteria.
  • Perform ongoing research to correct data and prevent duplicate providers, locations, payees, and participations.
  • Review and maintain credentialing information, including reviewing the National Practitioners Data Bank for adverse charges.
  • Track contract applications status and ensure all files have a Welcome, Denial, or Term Letter as appropriate.
  • Meet required turnaround times and accuracy rates.
  • Maintain fee schedules by creating, reviewing, and auditing provider fees.
  • Keep up-to-date provider enrollment process and records and track provider participation levels.
Requirements
  • High School diploma or equivalent, Associate's degree preferred.
  • 1-2 years of experience in a business environment.
  • Previous experience working with files or the collection and coordination of data preferred.
  • Proficient in the use of Excel and general computer software (Word, Outlook).
  • Ability to learn new software programs quickly.
  • Good basic math skills.
  • Excellent customer service skills.
  • Excellent verbal and written communication skills.
  • Professional and effective interaction skills with co-workers, clients, providers, and vendors.
  • Proven ability to work well individually and as a team member.
  • Ability to prioritize and organize multiple tasks.
  • Ability to remain organized with multiple interruptions.
  • Ability to make independent decisions.
  • Strong attention to detail.
  • Strong business acumen.
  • Ability to adapt to a constantly changing environment.

We offer a stimulating, productive work environment, competitive salaries, and a great benefits package. If you're looking for a challenging work environment where you will be asked to continually develop your skills, you've found the right place. We are a growing, financially sound company with many advantages to offer to our employees. Work-life balance is a reality at DentaQuest, as is our commitment to our employees' career advancement. DentaQuest is an equal opportunity employer.

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