Assistant Regional Director, Clinical Services
PACS
Provider Enrollment and Credentialing Support Specialist
Sun Life
full-time
Posted on:
Origin: • 🇺🇸 United States • Missouri, Wisconsin
Visit company websiteSalary
💰 $39,300 - $53,100 per year
Job Level
Junior
About the role
- Review Initial/Re-Apply Credentialing, Re-credentialing, privileging and onboarding for incoming providers
- Verify licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification
- Review contract and application for completeness
- Review National Practitioners Data Bank and federal/state OIG and SAM reports for exclusions
- Review state Medicare OPT Out report
- Monitor and report provider complaints and utilization management reports
- Assist with scheduling site reviews
- Enroll provider into payment system – Windward and enter provider info into Cactus
- Maintain integrity of provider information in Windward and Cactus and ensure files ready for committee
- Meet required turnaround time and accuracy rate
- Assist with department process improvements and NCQA certification activities
- Represent DentaQuest professionally and maintain confidentiality of credentialing information
- Other duties as assigned
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 in carrying out position duties
