Provider Specialist

DELTA DENTAL OF ILLINOIS • Naperville, IL

3d • $22 - $25 • Hybrid

About The Position

Provider Specialist - We offer a companywide bonus program, tuition reimbursement, volunteer time off, an on-site fitness center and the flexibility of a hybrid work schedule as described in our Workplace Flexibility policy. We are the largest dental insurance company and continue to grow. Based in Naperville, IL Delta Dental of Illinois has over 50 years of oral health experience and is dedicated to clients and employees alike. Our company culture is inclusive, innovative and focused on achieving our goals. We believe in improving oral health through our dental benefit programs and through our Foundation, which develops and supports projects and organizations that improve access to oral healthcare and oral health education. We’re looking for a Provider Specialist who can: Responsible for configuring and maintaining demographic data per network affiliation within multiple provider databases for claims payment and the publication of provider network directories. This complex process requires applying business rules to complete requests, cross-checking existing databases, primary source verification with state and federal regulatory agencies and accurate data entry within established timeframes. Apply critical thinking skills and attention to detail when processing dental network agreements within guidelines, review applications for thoroughness, communicate with the offices that fail to complete the application in its entirety, verify information and execute provider contracts to ensure seamless implementation of new or renewal contracts. Initiate and complete initial credentialing and annual re-credentialing activities within established timeframes. Maintain daily dashboard identifying metrics such as number of successfully credentialed providers as outlined in the Enterprise Credentialing Policies and Procedures Manual. Deliver service excellence to dental office inquiries in a courteous, professional manner regarding provider network / contract information, rules and regulations, policy and procedures, provider issues, change requests, portal assistance, and claim related inquiries. Process for electronic funds transfer enrollment, including establishing and maintaining bank records as needed. Accurately and efficiently complete a range of external audits including but not limited to: Provider Maintenance and Directory Accuracy.

Requirements

• Associate’s degree in business administration or other related field or minimum 3 years of provider contracting or provider service experience, preferably in medical or dental insurance industry
• Proven ability to resolve complicated requests requiring numerous steps, from start to finish
• Proven ability to learn, study, and master new computer systems, applications and processes; high level of proficiency with Microsoft Office (Outlook, Word, Excel, Teams).
• Proven ability to conceive and prepare comprehensive, detailed analyses
• Detail oriented and organized with the ability to multi-task and prioritize effectively.
• Flexible and ability to pivot quickly, comfortable in a fast-paced environment, and ability to work independently.
• Strong interpersonal, written and oral communication skills.

Nice To Haves

• Experience with business application tools such as Salesforce or PowerBI is preferred.

Responsibilities

• Responsible for configuring and maintaining demographic data per network affiliation within multiple provider databases for claims payment and the publication of provider network directories.
• Apply critical thinking skills and attention to detail when processing dental network agreements within guidelines, review applications for thoroughness, communicate with the offices that fail to complete the application in its entirety, verify information and execute provider contracts to ensure seamless implementation of new or renewal contracts.
• Initiate and complete initial credentialing and annual re-credentialing activities within established timeframes.
• Maintain daily dashboard identifying metrics such as number of successfully credentialed providers as outlined in the Enterprise Credentialing Policies and Procedures Manual.
• Deliver service excellence to dental office inquiries in a courteous, professional manner regarding provider network / contract information, rules and regulations, policy and procedures, provider issues, change requests, portal assistance, and claim related inquiries.
• Process for electronic funds transfer enrollment, including establishing and maintaining bank records as needed.
• Accurately and efficiently complete a range of external audits including but not limited to: Provider Maintenance and Directory Accuracy.

Benefits

• Free dental for employee and their dependents
• Competitive benefits: free vision, life, STD/LTD for employees/medical options for many budgets/401k and company match
• Generous PTO program; 11 paid holidays per calendar year
• Great people and culture
• Healthy work/life balance
• Conveniently located off of I-88

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree