Provider Relations Coordinator

Delta Dental of Missouri • St. Louis, MO

1d • Hybrid

About The Position

Join our team as a Provider Relations Coordinator and play a key role in maintaining accurate provider records, ensuring smooth credentialing, and supporting claims processing. If you're detail oriented, thrive on problem-solving, and enjoy building strong provider relationships, this hybrid role offers the perfect opportunity to make an impact.

Position Summary:
The primary responsibility of the Provider Relations Coordinator is to create and maintain Provider records in the enterprise and NPF systems. This process includes all updates related to 1099 records and the credentialling process. This position provides customer support for Providers to ensure appropriate processing of claims and communicates with Providers and PR Representatives with updates and findings.

Requirements

• High School diploma or equivalent.
• Strong verbal and written communication skills.
• Detail-oriented with a commitment to accurate and efficient claims processing.

Nice To Haves

• 3+ years’ experience in the dental industry or claims processing role preferred.
• Knowledge and experience in benefit determination and dental terminology preferred.

Responsibilities

• Creates and maintains Provider network data, including entering data for new providers, ensuring accuracy of external validation processes, reviewing contracts and new Credentialing Profiles, processing Provider record changes, investigating and re-mailing returned mail, and updating necessary address corrections.
• Ensures accurate completion of the credentialing and recredentialing process by gathering necessary documentation, accessing the National Provider database, reviewing provider applications, following up with Providers for additional information, creating and maintaining provider files and records and renewals, initiating the recredentialing process, and ensuring all network participants are credentialed in the timeframe required.
• Maintains the integrity of NPF data and conducts NPF Administrator functions, including reviewing NPF error reports, resolving issues, monitoring compliance with NPF participation, and updating NPF records.
• Researches and resolves issues impacting claims processing, including updating Provider data, assisting with provider and claims issues identified by Customer Service, gathering accurate information for claims processing, and processing the set up and maintenance of EFT information.
• Communicates with Providers and PR Representatives in a professional manner, providing updates on Provider updates, claims and open issues, contacting Providers to provide responses to questions and solutions to issues, collaborating with PR Representatives, and responding to calls and emails within a timely manner.
• Performs processes related to 1099 records, including maintaining Provider W-9 Records and filings, and validating claims payment dollars, tax id numbers and identification of entity names.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees