Credentialing Specialist

3 weeks ago

Woodbridge Virginia, United States Lightwave Dental Full time
About the Practice:

 

Lightwave, founded in 2016, is a high-growth company building the group model for the future of the dental industry. Lightwave is passionate about doing things the right way with a tight focus on high quality, core values, and taking care of their people. Lightwave is a dental leadership organization that focuses on partnering, training and developing dentists as the natural leaders of the dental practice. Lightwave helps dentists launch their careers, supports dentists leading high-growth dental groups, and assists doctors looking to establish their legacy as they transition into retirement. Lightwave is solving the big problems in dentistry: retirement, management, reimbursements, and partnership by providing the benefits of a group while preserving the essence of private practice. Lightwave currently supports over 80 dental offices in 4 states. For additional information, please visit . Follow us on , , and .

 

Job Description:
As part of LWD and the RCM/Payor Ops team, you will find yourself working with exceptionally talented and determined people committed to driving financial improvement, scalability, and process excellence. To support our practices and the growth of our company, this candidate must possess a strong passion for accountability, setting high standards, raising the bar, and driving results through constant focus on improving existing and future processes within Credentialing. This role will optimize reimbursement by proactively identify, develop, and execute critical process improvement initiatives to drive best practice performance.  The departments’ ultimate goal is to implement Delegated Credentialing within LWD.

Responsibilities:
Coordinates all aspects of credentialing

Ensuring the continuity of provider participation with insurance carriers (Payors) by managing the credentialing process and timely submission of required documents and Payor applications; follows up on any missing information needed to complete the credentialing process

Completes credentialing and re-credentialing application process of all Providers

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), vacation pay and paid time off.

Telecommute:
true

Travel:
25%

Requisition Number:
(phone number removed)

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