Sage Dental

Credentialing Specialist

• Adhere to NCQA guidelines.
• Audit Provider Licensure Files to NCQA guidelines.
• Pull Monthly Delegated Verification Files in accordance with NCQA.
• Knowledge of Delegated Verification Websites (ie. National Provider Data Base, etc.).
• Understanding of Initial and Re-Credential Delegated files / processing.
• Prepare and Present provider files for internal and external auditing.
• Upload and update the system and / or software with new documents.
• Request & Obtain any Licensure renewals.
• Must be able to utilize the licensure portals.
• Experience in Clearinghouse / Manual Education Verifications.
• Experience in Manual Hospital Privileges Verifications.
• Experience in Board Certification Verifications through the appropriate portals.
• Strong understanding of the differences between similar credentials (ie. Malpractice, Diplomas, etc.).
• Knowledge of what a Credentialing Committee consists of.
• Coordinate, monitor, maintain and process all internal re-credentialing to NCQA guidelines.
• Heavy Understanding of Attestation questions, actions, exclusions and explanations.
• Ability to speak effectively with providers, educators and internal departments.
• Assist offices and internal departments with credentialing issues.
• Ability to multi-task in a fast-paced environment.
• Work other projects as assigned.