Dental Associates

  • Credentialing Specialist

    Job Locations US-WI-Wauwatosa - Forum
    Job ID
    2019-1842
    Category
    Corporate Office
  • The Company

    An exciting career awaits you at Dental Associates’ Patient Financial Services office. We are a growing organization and continue to expand our footprint within Wisconsin. Dental Associates is a family owned company but with 14 clinics in Wisconsin we offer the stability of a large corporation and opportunity for growth.

    Company Perks

    • Potential for annual pay increases
    • Paid holidays, vacation and sick time
    • Insurance: Medical, Vision, Life, Voluntary, Short & Long-term Disability
    • Full dental coverage
    • Advancement opportunities
    • 401k company match
    • HSA and FSA accounts

    Responsibilities & Requirements

    The Provider Credentialing Specialist is responsible for timely and accurate credentialing of new and existing providers according to AAAHC and payer standards. The Provider Credentialing Specialist assists with customer business needs, while acting as a liaison between our providers, staff and vendors.

    • Responsible for verification of dental staff and allied health professional’s initial appointments, provisional review, reappointments and privilege delineation.
    • Examines applications for completeness and all required documentation, including employment gaps and adverse elements.
    • Performs primary source verification on all required credentials data elements and direct inquiries to all required data banks and licensing agencies in compliance with all accreditation, federal and state requirements.
    • Investigates discrepancies and missing information for the credentialing file.
    • Requests confidential information such as case logs, procedures and other sensitive matters as needed.
    • Completes payer applications, obtains signatures, and scans and mails documents by requested deadlines.
    • Monitors and tracks application status and credentials process.
    • Conducts ongoing monitoring of providers credentials and ensures receipt and entry of updated information.
    • Generates reports and provides management with information as needed.
    • Provides timely notification of credential expirations to providers, management and third parties.
    • Maintains credentialing database in a timely, complete and accurate manner.
    • Maintains shared department electronic files so they are accurate and easy to access.
    • Assists with AAAHC and NCQA credentialing compliance.
    • Collaborates with team members on system enhancements and process improvements to better serve internal and external customers.
    • Works closely with Credentialing Committee Chair/Vice-Chair on administrative activities of the committee, including preparing provider files for review and meeting minutes.

     

    Job Requirements:

    • BA or BS in Business, Health Care, or a related field preferred
    • A minimum of two years of credentialing experience in the medical or dental field.
    • Prior experience with PHI and HIPAA compliance.
    • A minimum of one year of customer service, insurance or general information systems technology experience, in addition to Microsoft Office. Intermediate Internet skills for both the WEB and Email applications.
    • Ability to investigate technical issues and work both independently and within a team.

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