Legal Marketing and Case Support Specialist
Job Duck
Provider Enrollment and Credentialing Support Specialist
Sun Life
full-time
Posted on:
Location: Missouri, Wisconsin • 🇺🇸 United States
Visit company websiteSalary
💰 $39,300 - $53,100 per year
Job Level
Junior
About the role
- Review Initial/Re-Apply Credentialing, Re-credentialing, privileging and oversee onboarding for incoming providers
- Verify provider licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification
- Review contracts and applications for completeness
- Review National Practitioner Data Bank and federal/state exclusion lists (OIG, SAM, Medicare OPT Out)
- Monitor and report provider complaints and utilization management reports
- Assist with scheduling site reviews and enroll providers into payment system (Windward)
- Enter and maintain provider information in credentialing database (Cactus)
- Ensure credentialing files are committee-ready and meet turnaround time and accuracy targets
- Assist with NCQA certification activities and department process improvements
- Represent DentaQuest professionally and maintain confidentiality of credentialing information
Requirements
- High School Diploma or equivalent
- 1 year job related experience
- Previous experience working with files or the collection and coordination of data preferred
- Knowledge of Dental terminology preferred
- Good interpersonal skills
- Ability to work independently
- Excellent oral and written communication skills
- Efficient PC skills (Word, Excel, Outlook, Work Flow Software, Time Tracking Systems)
- Ability to learn new software programs quickly
- Ability to prioritize and organize multiple tasks
- Ability to remain organized with multiple interruptions
- Good customer service and problem resolution skills
- Ability to navigate websites needed for credentialing purposes
- Ability to adapt to a constantly changing environment
- Ability to work in excess of 40 hours in a week
- Required to attend additional training as requested/deemed necessary
- Manual dexterity and sitting is required
