Credentialing Specialist
About The Position
The Credentialing Specialist’s primary role is to collect the appropriate provider documentation to enroll the provider in all the dental plans with which Great Expressions is contracted and the provider is eligible with. This position will be responsible for submitting initial enrollment applications, and all associated follow up on those applications. The Credentialing Specialist will also be responsible for verifying the accuracy of all submitted credentialing and enrollment information. This position is located at our corporate office in Southfield, MI and has a hybrid schedule of Monday, Tuesday, Thursday in office and Wednesday/Friday remote.
Requirements
- Associates degree or equivalent credentialing experience
- Prior experience with dental/health credentialing & provider enrollment
- Proficiency in Microsoft Outlook and Excel
- Excellent Communication skills and customer focus
- Analytical and problem solving skills with a passion for detail & accuracy
- Reliability and flexibility with time committed to the position
- Excellent organizational and time management ability
Nice To Haves
- CPCS or CPMSM certification a plus
Responsibilities
- Responsible for preparing enrollment applications for new and established providers within a region
- Ensures that applications are completed accurately, comprehensively and are sent out in a timely manner
- Organizes credentialing-related files and verifies that required documents for applications are collected from providers
- Validates that information on required documents match enrollment applications and ensure there are no discrepancies
- Recognizes, investigates, and validates discrepancies in information obtained from providers
- Submits enrollment applications, stores record of submissions and provides payors with additional information to if requested
- Follows up with payors proactively on pending applications in advance of a provider’s start date
- Collects effective date from payors and stores confirmation of enrollment
- Maintains practice management system with accurate information – submission dates, follow-up dates and effective dates as well other required data
- Responsible for Medicaid enrollment applications and re-validations prior to expiration date
- Responds to directory validation and other such requests from payors
- Proactively provides updates to regional team on providers and statuses on enrollment with payors and responds to any ad-hoc inquiries
- Demonstrates the ability to effectively prioritize tasks and set short/long term goals to achieve them
- Expresses thought clearly, concisely, and effectively both verbally and in writing.
- Ensures a free flow of information and communication upward, downward, and across the organization by actively listening
- Compiles, evaluates, and presents the provider specific data collected for review by one or more decision making bodies
- Assist with all re-credentialing request
- Sorts and handles mail
- Other tasks as requested by direct Manager
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
