MB2 Dental has an opening for a talented and motivated Credentialing Coordinator. This is an excellent opportunity to work for the fastest-growing dental partnership organization in the country.

We are a fast-paced company working hard to make our doctor partners' visions come to life. Unique individuals and ideas are always welcome here. If you are looking for an employer that supports you in reaching your maximum potential you'll feel right at home.

Think you're the right fit? We'd love to hear from you.

PROVIDER CREDENTIALING & RECREDENTIALING & ENROLLMENTS:

Obtaining, verifying, entering, and storing provider credentials within established timeframes and quality standards:

• Ensuring required credentials are received for initial credentialing and re-credentialing.
• Save credentials in established folders and uploading into Verity Stream (Credenal Stream), as appropriate.
• Data-enter credentials, payers, payer effective dates, and other pertinent information, as appropriate.
• Identify and forward items that need their attention to the appropriate coordinators.
• Enrolling providers to the appropriate insurers.
• Actively working to receive and document status and effective dates in Verity Stream (Credenal Stream), Monday Board software, Issue Trak (cheng system used internally), and other tools/software, as needed.
• Responding to re-credentialing requests with required credentials per payer.
• Store welcome letters/emails in the appropriate folder and upload them into Verity Stream (Credenal Stream) for each payer entry.
• Monitor and update Monday Boards, Issue Track, and Provider Rosters related to credentialing or enrollment without being asked.
• Notify offices of effective dates from each payer (forward welcome letters/emails or advise them directly from you).

CUSTOMER SERVICE/TROUBLESHOOTING:

Working interdepartmentally and externally to address issues with provider set-up, EOB research, and related information.

• Actively address issues reported with payments that may not be at expected reimbursement levels.
• Determine if there's an issue with the provider's network status with the payer versus what's in Verity Stream (Credential Stream) and showing in the office's PMS system.
• Determine if there is an issue with the proper fee schedule being attached by the payer.
• Seek to reprocess claims at the payer level to support the office without resubmitting (where possible).
• Approach each reported issue from the perspective of providing excellent customer service professional communications and addressing issues from a customer service perspective.
• Actively help others troubleshoot issues, especially where you may have some additional knowledge (e.g., an office was previously owned by you).

PARTNERING WITH OFFICES/PROVIDERS:

Demonstrate a sense of ownership and pride in working with your assigned offices to facilitate a positive impact in working with the credentialing department.

• Oversight of assigned offices/providers; providing timely, courteous, and thorough support.
• Provide consistent and timely follow-up on all outstanding items for our offices.
• Build an ongoing, collaborative rapport with office staff and providers.
• Ensure requests are bundled and communications appropriate (e.g., update/request items appropriately).

FEE SCHEDULE MAINTENANCE:

Working interdepartmentally and externally to ensure appropriate fee schedule attachment (to provide records with payers) and updating into office practice management systems.

• During provider enrollment, ensure the insurer attaches the appropriate fee schedule (e.g., mirroring other providers or, if a specific schedule, obtaining the schedule and notifying payers, per the current process).
• Monitor, update, and process fee schedule updates from Monday Board software and emails proactively.
• Work with Payer Strategy on the negation process to ensure new fee schedules received are attached to providers (notify payers, as the process may indicate).
• Store fee schedules in the appropriate folder with the proper name.
• Update office PMS systems accurately and within established timeframes.

COMMUNICATION:

Be professional and courteous, and communicate clearly with internal and external partners.

• Ensure proper grammar and business etiquette in all interactions.
• Strong follow-through, keeping follow-up commitments.

ADDITIONAL:

• Participate in special projects, including working overtime as needed.
• Perform other related dues as assigned by leadership.
• Be proactive and interactive; demonstrate strong, positive teamwork.
• Develop an individual growth plan with areas you'd like to improve and build strength to increase your collaborative bandwidth and professional goals.

REQUIREMENTS :

• High school diploma or equivalent.
• 1 years of job experience preferred.
• Dental or health experience is a plus but not required.
• Dental or health insurance (PPO/HMO/Medicaid, EPO, Discount Plans, etc.) enrollment/credentialing experience is preferred but not required.
• Strong background in customer service is required, whether externally or internally facing.
• Trouble-shooting strong attention to detail and follow-through.
• Proficient with Microso Office (Word, Excel & Email Outlook), Adobe Pro, and an ability to learn new computer applications.
• Verity Stream credentialing software experience is a plus but not required.
• Strong administrative and data entry skills.
• Great verbal & written communication.

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