Provider Enrollment & Credentialing Support Specialist
Sun Life
full-time
Posted on:
Location Type: Hybrid
Location: Des Moines • Iowa • United States
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Salary
💰 $40,600 - $54,800 per year
Job Level
About the role
- Candidate must reside in the state of Iowa
- Provider Enrollment and Credentialing Specialist reviews all aspects of the Initial/ Re-Apply Credentialing, Re-credentialing, privileging and overseeing the onboarding process for all incoming providers
- Primary responsibilities include verifying all the credentialing criteria for practitioners that have applied to the network, including follow up with practitioners as needed to obtain information
- Verify potential and existing provider’s licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification
- Contract Validation: 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
- Ensures 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
- Maintains confidentiality of the credentialing information
- Other duties as needed or required
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
Benefits
- generous vacation and sick time
- market-leading paid family, parental and adoption leave
- medical coverage
- company paid life and AD&D insurance
- disability programs
- partially paid sabbatical program
- 401(k) employer match
- stock purchase options
- employer-funded retirement account
- flexible, inclusive and collaborative work environment that supports career growth
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
credentialingprovider enrollmentcontract validationdata collectiondata coordinationlicensure verificationNPI verificationinsurance verificationboard certification verificationNCQA certification activities
Soft Skills
interpersonal skillsindependent workoral communicationwritten communicationcustomer serviceproblem resolutionorganizational skillsprioritizationadaptabilityconfidentiality
Certifications
High School Diploma