This position is responsible for coordinating initial and re-credentialing applications for network dentists, ensuring compliance with standards and regulatory requirements. The Credentialing Specialist will maintain accurate provider data, manage provider directories, and serve as a point of contact for providers and leased networks.
Location:Evansville, Indiana, United States
Responsibilities:
- Gather, verify, track, and maintain an audit trail of all elements outlined in the Plan's credentialing and re-credentialing policies and procedures.
- Provide administrative support for credentialing and re-credentialing, including preparing accurate correspondence and reports related to provider applications.
- Maintain working knowledge of credentialing and re-credentialing standards and communicate with the Dental Review Team as needed for application review.
- Manage provider contracts and fee schedules.
- Ensure dentist files are current with licensure, DEA certificates, malpractice insurance coverage, malpractice claims history, and National Practitioner Data Bank requirements.
- Run quarterly provider adequacy and accessibility reports.
- Maintain Commercial and Medicare provider directories.
- Upload updated provider directories to Medicare and health plans monthly.
- Complete network verification to meet state requirements.
- Process provider updates in the system and notify providers upon completion.
- Support accounting with TIN verification as needed.
- Process member letters related to provider terminations.
- Serve as a direct contact for provider offices requesting verification or additional information.
- Act as the primary contact for leased networks, including requesting reports and provider data.
- Perform data entry into electronic medical database systems.
- Document patient care and related duties appropriately.
- Perform selected patient registration activities.
- Coordinate equipment/supply needs.
- Notify appropriate department of equipment malfunction.
Required Skills & Certifications:
- 1+ years of credentialing experience (medical or provider experience accepted)
- Tech-savvy with credentialing software and Excel
- High School Diploma or GED
Preferred Skills & Certifications:
- Prior insurance industry knowledge and familiarity with terminology
Special Considerations:
- This is an onsite role.
- The role is covering a leave of absence.
- The role could extend depending on how long coverage is needed beyond the 13-weeks.
Scheduling:
- Not specified.
...Description Launch Your Auto Claims Career with a Fortune 100 Company! No Claims Experience Needed, Paid Training & Licensing Included! Location: PLANO... ...Claims Representative. As a licensed claims adjuster, you will be fulfilling the promise we made to...
...Takeda: High school diploma or equivalent Ability to walk and/or stand for the entire work shift Will work evenings, weekends, and holidays Ability to lean, bend, stoop, crouch, and reach above shoulders and below knees Ability to lift to 5 lbs., and...
...HUDSON LIGHT AND POWER DEPARTMENT Class A Lineman The Hudson Light and Power Department (HLPD), located in Hudson Massachusetts, is seeking to fill a Class A Lineman position at its Forest Avenue facility. This position will report to the General Line Foreman...
...process can take many forms, including an interview or exam, depending on the job. Position is located in the Health Quality Investigation Unit (HQIU) Glendale Field Office. This recruitment is until filled and applications will be reviewed on a monthly basis. The...
Trust Officer Employee Benefits | IRA | 401K | ESOP/KSOP We are seeking a knowledgeable and relationship-driven Trust Officer to administer and grow a portfolio of fiduciary accounts. This role is responsible for comprehensive client relationship management across Investment...