Credentialing Specialist

KIDS CARE DENTAL AND ORTHODONTICS•Rancho Cordova, CA

1d•$30 - $32

About The Position

The primary duty of the Credentialing Specialist is to ensure that all doctors are properly credentialed with all participating PPOs and that their supporting documentation is always current. This person also contributes to the Revenue Recognition department in the overall functions of the dental billing and claim process and as a complete support system to all practices and family inquires. This position adheres to all policies and procedure to meet company standards under the direction of the RR Manager

Requirements

High school diploma or G.E.D
2 years or more experience in dental and or medical billing field
Excellent customer service
Strong attention to detail
Ability to multi-task and work in a fast paced environment
Time management
Experience in posting insurance claim payments and adjustments
Strong and professional communication skills via phones and or emails
Strong computer and data entry skills
Knowledge of PPO insurance plans / billing
Knowledge of dental insurance claims

Nice To Haves

Knowledge of Dentrix, and Trojan systems preferred but not required

Responsibilities

Interact with the doctors to complete and submit all necessary PPO applications
Maintain and monitor critical dates for updating credentialing files
Contribute to the Billing department and Dental Practices through positive attitude, respectful interaction and efficiency
Answer phones in a professional and timely manner
Answer question about dental insurance, ledgers, and all other aspects of the claims and billing process to families, team members and practice managers to resolve all issues by discussing contracts with third party payers; explain insurance eligibility benefits
Process electronic and manual claims both primary and secondary in a timely manner
Post insurance payments, allocating adjustments and minimizing write offs whenever possible
Insurance Aging Management (to meet department standards)
Time management and attention to detail
Weekly reports according to policy and procedures and department needs
Work daily transmission reports
Generate patient statements in a timely manner, daily and/or weekly
Collections to include: collections calls, patient letters, and any additional policy and procedures that pertain to the collection process
Clear and descriptive documentation on all accounts via insurance claim and G-notes
Manage receivables; balance to company standards with attention to detail
Generate month end reports as well as the month end in a timely manner
Other duties as assigned to meet business needs