Credentialing / Enrollment Specialist - Multilocation Dental Group

DSO Provider Credentialing

Sign-on Bonus: $2,500

This position earns $24 - $30/hour plus BONUSES, with conversion to salary based on experience. We also offer medical insurance, flexible spending accounts (FSAs), a 401(k) plan, paid time off (PTO), Aflac, Sign-On and Referral Bonuses, and more.

Description:

The Credentialing / Enrollment / Managed Care Expert will be responsible for compiling a comprehensive list of Organizational Entities, Provider information, and Managed Care Contracts from our current solution and supporting a migration plan to a new Provider Enrollment software solution. This critical role will build close relationships with recruitment, onboarding revenue cycle, and providers to enroll clinicians with Payers, inform Providers of credentialing matters, and maintain positive relationships with Insurance representatives. Information will be continually updated through online portals and consolidated within our new centralized document repository and credentialing system. This leader will serve as a subject matter expert on Payer fee schedule updates, Provider credentialing requirements, and Onboarding programs. The organization is essential to data integrity with timely and accurate maintenance of relevant materials.

This position is located in Suffern, NY, and requires one to work in person Daily a week, M-F 9-5 pm or alternate hours with the option of earning remote days with time in the role.

Experience / Education:
• A minimum of 2+ years of experience in medical or dental credentialing or roles directly handling these processes is required.
• High School Diploma, minimum.
• Associate or bachelor's degree preferred.
• Relevant experience preferred

Key Functions:
• Updates Provider informational worksheets and hard copy.
• Insurance company enrollment for clinicians and payment processing required.
• Provider, Facility and Location Enrollment with Medicaid, Commercial and 3rd party Networks
• Maintaining CAQH and NPPES registries.
• Serve as liaison with billers and other departments for payer coordination.
• Consistently completes all required work within the time frame requested.
• Computer proficient in MS Office (Word, Excel, Powerpoint & SharePoint)
• Internet savvy
• Experience with Credentialing Software and Enrollment form submission
• Excellent communication skills.
• Strong Organization skills.

Knowledge / Skills / Abilities
• Excellent interpersonal, problem-solving, and verbal and written communication skills.
• Ability to effectively convey information and collaborate with internal and external customers, including staff, health plan management, governmental agency personnel, provider panel program, and/or other applicable customers as assigned.
• Brief knowledge regarding insurance plans, coding, auditing, and contract compliance.
• Coordinates and maintains a system for receiving, processing, and resolving provider and member appeals and grievances following all applicable contract provisions, plan policies, procedures, rules, and regulations.
• Will be trained to manage the policy and procedures according to Federal and State regulations
• Analysis of trends for internal monitoring purposes and external reporting.
• Manages the communication with the Medicaid, Medicaid CMOs, commercial insurance plan, or related program.
• Manages turn-around times/response times.
• Assessment and performance review and coordinating Medicaid audits with the appropriate internal staff, claims, customer service, provider credentialing, etc.
• Responsible for the contract deliverables and reports as outlined in the contracts.
• Identifies compliance issues and implements corrective action plans.
• Additional responsibilities as assigned.

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