Job Description

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.

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