Credentialing Representative

29777 Telegraph Rd, Southfield, MI 48034, USA Req #1144 Tuesday, April 16, 2024

What you’ll do

The Credentialing Specialist’s primary role is to collect, and primary source the necessary and appropriate provider documentation according to NCQA accreditation standards.

Also, to enroll the provider in all of the dental plans with which Great Expressions is contracted and the provider is eligible for enrollment.

This position will be responsible for submitting initial credentialing and enrollment applications, and all associated follow up on those applications.

The Credentialing Specialist will also be responsible for verifying the accuracy of all submitted credentialing and enrollment information, and for creating, or auditing accurate Primary Source Verification files.

This position is based in the GEDC Practice Support Center in Southfield, MI, and will require a daily commute and presence in the office, if residing in the Metro-Detroit area.

What you’ll bring to the team

• Excellent Communication skills and customer focus
• An understanding of revenue cycle
• Analytical and problem solving skills with a passion for detail & accuracy
• Reliability and flexibility with time committed to the position
• Excellent organizational and time management ability
• Proficiency in Microsoft Outlook and Excel

What we require you have

• Bachelor’s Degree or equivalent credentialing experience.
• Prior experience with dental / health delegated & traditional credentialing
• High volume, fast-paced office experience a plus
• Organizes work, effectively prioritizes, and sets short or long-term goals and strategies to achieve them. Aligns communications, processes, and resources to drive success.
• Verifies the accuracy of credentialing applications and CAQH Profile information for each assigned provider.
• Ensures that all assigned credentialing and enrollment applications are completed accurately, and sent out in a timely manner.
• Compiles, evaluates, and presents the provider specific data collected for review by one or more decision making bodies.
• Recognizes, investigates, and validates discrepancies and adverse information obtained from the application, primary source verifications, or other sources.
• Provides responses to external / internal queries regarding a provider’s status.
• Organizes credentialing data, and files.
• Follows up with payers in a timely fashion to ensure all effective dates have been collected before a provider’s start date.
• Completes necessary doctor re-credentialing within 90 days of re-cred due date.
• Ensures that the practice management software has current information including : effective dates, audit dates, and submissions dates, and other data as required.
• Expresses thought clearly, concisely, and effectively both verbally and in writing. Ensures a free flow of information and communication upward, downward, and across the organization by actively listening.
• Values and models integrity and honesty by acting in a just, fair, and ethical manner and encouraging ethical behavior among others.

Inspires trust and confidence among stakeholders through reliability, authenticity, and accountability.

• Responds to directory validation and other such requests from payers.
• Assists with Payer audits, as needed,
• Submits rosters and other reports to delegated payers.
• Sorts and handles mail.
• Other tasks as requested by direct Manager

About GEDC

Since 1982, Great Expressions has been at the forefront of dental innovation, setting the standard for exceptional care and unforgettable patient experiences.

We're channeling our resources and energy into revolutionizing our technology platform, expanding service offerings, and creating a personalized patient experience that goes beyond the expected.

At Great Expressions, we're not just transforming dentistry; we're investing in the growth and development of our team. Join us and be a part of a career that blends innovation and professionalism, where your contribution shapes the future of dental excellence.

GEDC is committed to diversity and inclusion and is proud to be an equal opportunity employer. All qualified applicants are welcomed and encouraged to apply.

Last updated : 2024-04-26