Provider Onboarding and Credentialing Specialist

Unum•Portland, ME

2d•$36,000 - $62,400

About The Position

The Provider Onboarding and Credentialing Specialist will be responsible for ensuring a successful onboarding for new in network dental PPO, dental DHMO, and vision providers. They are responsible for taking the completed provider application and information, entering the data into the Salesforce System for tracking, reviewing and managing incomplete information and gathering of necessary information from the provider, and doing all initial credentialing and recredentialing of providers in compliance with internal standards, policies and procedures. This includes entering data, performing appropriate credentialing verifications, and preparing files for various internal and external entities. The Specialist will assist in conducting Credentialing Delegation Reviews as well as preparation and delivery of monthly and quarterly reporting as requested.

Requirements

Bachelor’s degree preferred or equivalent experience
0-2 years’ experience in Provider Relations and Credentialing or equivalent experience preferred
Excellent verbal and written communication skills
High level of accuracy and attention to detail
Ability to gain high level of knowledge involving intricate aspects Systems of Record
Strong customer service philosophy
Critical thinking and problem-solving abilities
Ability to thrive in a fast-paced environment and meet assigned deadlines
Demonstrated ability to adopt change to improve process, efficiency, and service.
Demonstrates consistency in accuracy, speed, and quality of work.

Responsibilities

Manage pending/incomplete contracts and workflow to efficiently gather all missing contracting documents
Identify errors in initial contracting and missing items for completion
Contribute to individual quality/production expectations to ensure the achievement of organizations turnarounds time expectations
Perform a check on contracts to make sure appropriate fee schedules for area is utilized
Work closely with Provider Network Recruitment to communicate and follow-up on missing contract elements
Input contract data into provider databases while ensuring the accuracy of the data
Responsible for entering in contracts in a timely manner for monthly metrics and recruitment reporting
When requested may assist with Credentialing Delegation Reviews by presenting credentialing files to various Delegated Entities and/or reviewing credentialing files, policies and procedures and other monitoring reports to ensure compliance of various Delegated Entities
Works directly with providers to ensure all necessary credentialing information has been received prior to beginning the credentialing process
Enters provider data into appropriate data management systems
Performs all credentialing verifications necessary to complete the credentialing process while maintaining the appropriate compliance standards
Prepares and presents providers records for Credentialing Committee Review
Notifies providers of credentialing decisions within compliance timeframes
Performs provider re-credentialing, at least every 36 months in compliance with NCQA standards
Assists in monitoring of license expirations and any change in status and takes action when appropriate
Educates providers regarding criteria and credentialing policies and procedures when necessary
Works with Network Management to ensure providers’ initial information and updates are sent for processing timely and accurately
Assists Network Management and Support staff with provider data management as it relates to adding new providers in System of Record
Sends all approval and welcome kits to providers in a timely manner
Always maintains provider and patient confidentiality
Provides positive, supportive, communication to providers at all times
Collaborates with other departments and outside agencies to meet identified needs of the providers and their patients, while also ensuring credentialing staff cooperation
May perform other duties as assigned, including special projects and initiatives.