Credentialing Coordinator

Pay rate: $17/hr on W2 + Health Insurance

This position is responsible for maintaining the integrity of provider information on enterprise systems including overseeing the distribution of updated information requested by dental offices. Other responsibilities include assisting in nurturing positive relationships between the health plan, providers and practice managers.

• Maintains the integrity of an electronic database and assists dental providers offices with business name changes, tax , termination of dental contracts, change of ownership, business splits, sale of practices, adding additional associates, license changes, dental specialty changes, updated contract information, and provider directory assistance.
• Work individually or with a team to solve complex problems related to provider servicing.
• Sometimes acts as a technical resource to others in own function.
• Works various workflow queues for claims where address tax identification number conflicts with the provider file data.
• Handles escalated calls from client groups as well as outgoing calls to dental offices.
• Resolves 1099 tax discrepancies with provider offices; verifying with external databases.
• Runs queries; generates monthly reports and credentialing document verification requests.
• Screens provider enrollment packets for missing information and requests missing information from the provider.

• Knowledge of Current Dental Terminology (CDT) codes and dental nomenclature.
• Ability to type 40 words per minute with no more than two errors.
• Knowledge of the company's claims processing systems, claims flows and adjustment notices.
• Must be flexible to work any shift and willing to work overtime as needed.
• A high school diploma or GED
• A minimum of 2 years related experience (Managed Care or Medical/Dental Insurance experience).