Dental Credentialing Coordinator

ProMedica•Evansville, WY

13d•Onsite

About The Position

This position is responsible for gathering, verifying, tracking, and maintaining an audit trail of elements outlined in the Plan's credentialing and re-credentialing policy and procedures. This includes liaison activities with primary sources for new or established Dentists. The role provides administrative support in the area of credentialing and re-credentialing, including accurately typed correspondence and reports regarding provider applications. The coordinator will maintain a working knowledge of the credentialing and re-credentialing process and other standards, and communicate with the Dental Review Team when needed to gather their expert opinion on an application for credentialing. Responsibilities also include management of provider contracts and fee schedule management. The role ensures that Dentist files are maintained with current information on licensure, DEA certificates, malpractice insurance coverage, malpractice claims experience, and other pertinent data, including National Practitioner Data Bank reporting requirements. The position involves running provider adequacy reports and accessibility reports on a quarterly basis, maintaining provider directories (Commercial and Medicare), and uploading provider directories for Medicare and Health Plans monthly. Network verification to meet state requirements, processing provider updates in the system, and providing support to accounting with TIN verification are also key duties. The coordinator will process member letters regarding provider terms and serve as a direct contact for provider offices needing verification and additional information. This role is the main contact for leased networks with GEHA, including requesting reports and provider data, and completing GEHA Compliance quarterly outreach. It acts as a point of contact for dental offices when Dental Network Representatives are out in the field, provides marketing support for projects with dental offices, and assists in report generation for the department.

Requirements

High School Diploma or GED required.
Excellent computer skills, including Word and Excel or similar software.
Must have excellent interpersonal skills necessary to communicate effectively with callers, physicians and offices.
Strong customer service orientation and interpersonal skills for positive relationship building.
Must possess good organizational and priority setting skills and exercise independent judgment with minimal guidance and supervision.
Self motivated and directed with the ability to effectively prioritize and execute tasks in a high pressure environment.
Team oriented within the Operations area in order to maintain a collaborative environment for problem solving.
One to two years experience in telephone-based customer service preferred.

Nice To Haves

Associates degree.
Strong knowledge base of dental billing office practices, including practice management computer system experience preferred.
Demonstrate knowledge of ADA/CDT coding regulations and requirements preferred.
Basic knowledge of insurance regulations.

Responsibilities

Gathers, verifies, tracks, and maintains an audit trail of elements outlined in the Plan's credentialing and re-credentialing policy and procedures.
Provides administrative support in the area of credentialing and re-credentialing.
Maintains a working knowledge of the credentialing and re-credentialing process and other standards.
Communicates with the Dental Review Team when needed to gather their expert opinion on an application for credentialing.
Manages provider contracts.
Manages fee schedules.
Ensures that Dentist files are maintained with current information on licensure, DEA certificates, malpractice insurance coverage, malpractice claims experience, and other pertinent data, including National Practitioner Data Bank reporting requirements.
Runs provider adequacy reports and accessibility reports on a quarterly basis.
Maintains provider directories (Commercial and Medicare).
Uploads provider directories for Medicare and Health Plans monthly.
Completes network verification as necessary to meet state requirements.
Completes any provider updates in the system and sends notification of completion to the provider.
Provides support to accounting with TIN verification as necessary.
Processes member letters regarding a provider term.
Serves as a direct contact for provider offices needing verification and any additional information as requested.
Acts as the main contact for leased networks with GEHA (requesting reports and provider data).
Completes GEHA Compliance quarterly outreach.
Serves as a point of contact for dental offices when Dental Network Representatives are out in the field.
Provides marketing support for projects with dental offices.
Assists in report generation for the department.