Description

Duties and Responsibilities

1. Coordinates, and monitors the review and analysis of dentist applications and accompanying documents, ensuring applicant eligibility.


2. Conducts thorough background investigation, research and primary source verification of all components of the application file.


3. Identifies issues that require additional investigation and evaluation, validates discrepancies and ensures appropriate follow up.


4. Responds to inquiries from other healthcare organizations, interfaces with internal and external customers on day-to-day credentialing issues as they arise.


5. Assists in credentialing audits; conducts internal file audits.


6. Works closely with Accounts Receivables team to facility timely payment of insurance claims.


7. Works closely with Accounts Receivables team on special projects.


8. Performs miscellaneous job-related duties as assigned.

Qualifications

Minimum Job Requirements

GED, 3 years of experience in dental/medical office administration or credentialing.

Knowledge, Skills and Abilities Required

•Ability to communicate effectively, both orally and in writing.

•Beginner to Intermediate Excel skills.

•Knowledge of medical/dental credentialing procedures and standards.

•Working knowledge of dental operations and procedures. Prior dental experience helpful, but not required.

•Informational research skills.

•Ability to use independent judgment to manage and impart confidential information.

•Ability to make administrative/procedural decisions and judgments.