Customer Support

• Verify potential and existing provider’s licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification.
• Review contract and application for completeness.
• Review National Practitioners Data Bank for adverse charges pending or filed against Provider.
• Review federal and/ or state OIG and SAM report for exclusion from the Medicaid or Medicare program.
• Review state Medicare OPT Out report for exclusion from the Medicare program.
• Monitors and reports provider complaints and utilization management reports.
• Assist with scheduling site reviews.
• Enroll the provider into payment system – Windward.
• Enter all provider information into credentialing database – Cactus.
• Maintain the integrity of the provider information in Windward and Cactus.
• Ensure credentialing file is in order with any issues flagged for committee.
• Meet required turnaround time and accuracy rate.
• Assist with other duties as assigned.
• Assist management in the implementation of department process improvements.
• Assist with the ongoing NCQA certification activities.
• Represent DentaQuest in a professional manner at all times while communicating with internal and external requestors.
• Maintain confidentiality of the credentialing information.

Provider Enroll & Credentialing Support Specialist

Technical Customer Care Specialist

Director, Customer Support

Customer Support Specialist

Customer Care Supervisor

Customer Care Specialist