Provider Data Maintenance & Credentialing Specialist I - Primarily Remote in Jacksonville, FL

External•Jacksonville, FL

3d•$40,000 - $50,000•Hybrid

About The Position

This position is primarily a remote role with an on-site presence required for a single day every few weeks. The specialist conducts provider credentialing application and contract package review prior to processing, and performs timely data entry of provider application information and contract arrangements into the administrative system. They are also responsible for preparing adverse files for review by the Dental Credentialing Committee, updating and maintaining contract and demographic information on participating providers, and generating correspondence to providers confirming contract or demographic changes, credentialing status, and requests for missing or incomplete information. General assistance with projects is also required.

Requirements

Experience in the health or dental insurance industry
Excellent communication skills including the ability to address a wide range of audiences
Customer service skills
Basic MS Office skills
Ability to read documents and extract information
Ability to understand and evaluate contractual language
Ability to work within time constraints and maintain attention to detail
Ability to prioritize workflow and work independently but coordinate efforts within a team
High school diploma or equivalent
2 - 4 years of related experience
Or, equivalent military experience

Nice To Haves

Associate's Degree with 3 years of related experience

Responsibilities

Enters credentialing and re-credentialing applications into the administration systems.
Conducts follow-up as necessary with Credentialing Verification Organization to obtain completed Primary Source Verification credentialing report in a timely manner.
Communicates with providers regarding missing information from credentialing files and requests additional information from external agencies.
Reviews credentialing reports loaded into the administration system for accuracy
Performs timely data entry of contract arrangements into administration system following credentialing.
Updates and maintains contract and demographic changes ensuring accurate reporting, claims payment and directory information.
Ensures timely follow-up is conducted to secure missing information.
Generates letters to providers following contract or demographic maintenance.
Meets or exceed departmental and individual metrics goal expectations as required by productivity and quality.
Prepares documents for contract execution
Processes adverse files including researching information with appropriate agencies.
Prepares adverse reports for review by the Dental Credentialing Committee.
Performs telephonic and written correspondence outreach to providers for any missing, expired or incomplete documentation.
Performs other related duties and responsibilities as assigned

Benefits

A culture that values employees and celebrates, empowers, and inspires a diverse workforce
Outstanding and affordable benefits package
PTO provided at date of hire
11 paid holidays
401(k) with up to 6% match; fully vested from day 1
Remote opportunities with company-provided equipment
Team-oriented, collaborative group of peers
Career advancement opportunities
Tuition Reimbursement
Employee Assistance Program
Inclusion Council and Employee Resource Groups
Recharge Days and Volunteer Time Off