Provider Enroll & Credentialing Support Specialist, DentaQuest

Sun Life • Wellesley, ME

20h • Hybrid

About The Position

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week. The opportunity: Provider Enrollment and Credentialing Specialist reviews all aspects of the Initial/ Re-Apply Credentialing, Re-credentialing, privileging and overseeing the onboarding process for all incoming providers. Primary responsibilities include verifying all the credentialing criteria for practitioners that have applied to the network, including follow up with practitioners as needed to obtain information

Requirements

• High School Diploma or equivalent.
• 1 year job related experience
• Previous experience working with files or the collection and coordination of data preferred.
• Knowledge of Dental terminology preferred.
• Good interpersonal skills.
• Ability to work independently.
• Excellent oral and written communication skills.
• Efficient PC skills (Word, Excel, Outlook, Work Flow Software, Time Tracking Systems).
• Ability to learn new software programs quickly.
• Ability to prioritize and organize multiple tasks.
• Ability to remain organized with multiple interruptions.
• Good customer service and problem resolution skills.
• Ability to navigate websites needed for credentialing purposes.
• Ability to adapt to a constantly changing environment.
• Ability to work in excess of 40 hours in a week.
• Required to attend additional training as requested/deemed necessary.
• Previous experience working with files or the collection and coordination of data preferred.
• Knowledge of Dental terminology preferred.
• Incumbent must be able to communicate effectively.
• Manual dexterity and sitting is required in carrying out position duties.

Responsibilities

• Verify potential and existing provider’s licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification.
• Contract Validation: Review contract and application for completeness.
• Review National Practitioners Data Bank for adverse charges pending or filed against Provider.
• Review federal and/ or state OIG and SAM report for exclusion from the Medicaid or Medicare program.
• Review state Medicare OPT Out report for exclusion from the Medicare program.
• Monitors and reports provider complaints and utilization management reports.
• Assist with scheduling site reviews.
• Enroll the provider into payment system – Windward.
• Enter all provider information into credentialing database – Cactus.
• Maintain the integrity of the provider information in Windward and Cactus.
• Ensures credentialing file is in order with any issues flagged for committee.
• Meet required turnaround time and accuracy rate.
• Assist with other duties as assigned.
• Assist management in the implementation of department process improvements.
• Assist with the ongoing NCQA certification activities.
• Represent DentaQuest in a professional manner at all times while communicating with internal and external requestors.
• Maintains confidentiality of the credentialing information.
• Other duties as needed or required.

Benefits

• At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.
• Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.
• Enjoy a flexible, inclusive and collaborative work environment that supports career growth.
• We’re proud to be recognized in our communities as a top employer.
• Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees