Dearborn Group

QA Engineer

• Responsible for performing oversight on essential credentialing functions to attain and maintain quality providers in the dental network.
• Conducts audits for credentialing as well as network data quality.
• Understands credentialing policies and procedures per NCQA, URAC and CMS standards and other regulatory requirements.
• Serves as a liaison to delegated entities and vendors to ensure current and adequate credentialing process are in place.
• Develops and performs queries for data reporting purposes to include directories, ad hoc reports, and network management reports.
• Responsible for the monitoring and maintenance of credentialing and re-credentialing polies and program as well as state and federal requirements to ensure compliance is met.
• Provides operational and industry knowledge to ensure credentialing practices.

Credential Analyst – NCQA, URAC, CMS