What are the responsibilities and job description for the Delegated Credentialing Specialist position at Great Expressions Dental Centers?
Overview: Our Credentialing Department is hiring for a Delegated Credentialing Specialist.
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.
With over 275 offices in the United States, GEDC is consistently recognized for contributions to improving oral health through quality and safety initiatives, affordable dental care services, patient convenience, research and more.
When you join our team, you benefit in many ways:
COVID-19: Great Expressions and all supported dental offices comply with all local, state and federal regulations. Employment is contingent upon an individual's continued compliance with regulations and Great Expressions' policy, including COVID-19 vaccination or testing. Responsibilities:
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.
With over 275 offices in the United States, GEDC is consistently recognized for contributions to improving oral health through quality and safety initiatives, affordable dental care services, patient convenience, research and more.
When you join our team, you benefit in many ways:
- Exciting Team Environment
- Competitive Pay
- Healthcare Benefits
- Medical, Dental, and Vision coverage offered
- Accident Coverage
- Hospital Indemnity Coverage
- Paid Holidays and Vacation Time
- Company Paid Uniforms
- 401k, Life Insurance, Short and Long Term Disability plans
- ID theft protection
- Opportunity for Career Advancement/Recognition and Growth with a Rapidly Growing Company
- Tuition Reimbursement
- Power of One Rewards
- Convenient New Hire Orientation for all team members
- Pet Insurance
COVID-19: Great Expressions and all supported dental offices comply with all local, state and federal regulations. Employment is contingent upon an individual's continued compliance with regulations and Great Expressions' policy, including COVID-19 vaccination or testing. Responsibilities:
- 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.
- Submits Medicaid enrollment applications in a timely fashion.
- Completes Medicaid re-validations prior to the expiration date.
- 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.
- Submits rosters and other reports to delegated payers.
- Sorts and handles mail.
- Other tasks as requested by direct Manager.
- 2 year degree or equivalent credentialing experience.
- Prior experience with dental/health credentialing & provider enrollment
- 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