The Credentialing Representative is responsible for providing support to our facilities and doctors to be credentialed and ensures that the credentialing and privileging process runs smoothly.
JOIN OUR ORGANIZATION...
D4C Dental Brands, Inc. is a dental support organization (DSO) that supports affiliated pediatric dentists, general dentists, and orthodontists in the Smiles For Life Network. We provide business management expertise and administrative operations support, so doctors can focus on their patients and clinical operations. Our team is dedicated to helping children achieve a lifetime of great oral health. Our locations offer an exciting and comforting environment for patients as our specialists deliver best-in-class care and treatment to all. Join us and take part in raising the standard in children’s oral healthcare!
The Credentialing Coordinator will be responsible for responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process.
•Liaison between the practitioners, health plans, hospitals and patient care facilities and all related entities regarding credentialing, malpractice coverage, and practitioner enrollment.
•Manage credentialing and re-credentialing process and applications with units and health plans, which includes obtaining, reviewing, and completing doctor credentialing and re-credentialing applications; contacting doctors for additional documentation if required; monitoring applications for timely approval and follow-up as needed.
•Management of CAQH applications including completion and updates. Sets up and maintains provider information in online credentialing databases and systems.
•Responsible for all necessary updates including, but not limited too address changes, NPI updates, etc.
•Ensures facility addresses, provider information is current with health plans, agencies and other entities.
•Coordinate, compile, and prepare reports pertaining to doctors as requested. Preparation of correspondence associated with the credentialing process.
•Maintains knowledge of current health plans and agencies requirements for credentialing doctors.
•Tracks license and certification expirations for all practitioners to ensure timely renewals. Follow-up with practitioners regarding expiring documents to ensure compliance.
•Performs other duties as assigned.
EDUCATION AND EXPERIENCE:
High school diploma; Bachelor’s degree preferred.
NAMMS Certifications is a plus.
2-3 years experience in managed care credentialing and Medicaid and Medicare enrollment (electronic for both PECOS and Medicaid)
SPECIFIC SKILLS :
Excellent written, verbal, and presentation communication skills
Knowledge of IntelliSoft is a plus
Knowledge of dental or medical credentialing process
Proficient in Microsoft Office, specifically Word, Excel and Internet and Outlook applications