Credentialing Representative

COAST DENTAL•Tampa, FL

1d•Onsite

About The Position

The Credentialing Representative is responsible for maintaining all dentist professional licenses, enrolling new dental providers with all insurance plans, maintaining in-network privileges for existing dental providers and other duties related to dental provider credentialing.

Requirements

Provider credentialing or dental insurance experience a plus.
Advanced MS Outlook, Word and Excel.
Ability to multi-task and manage several projects at one time.
Ability to work in a fast-paced environment.
Ability to handle sensitive information and maintain confidentiality.
Ability to work independently and in a team environment.

Nice To Haves

Credentialing experience, preferred.

Responsibilities

Reconcile monthly, weekly and biweekly extracts from contracted insurance carriers to ensure accuracy of provider demographic information and credentialing status.
Completes network accuracy reconciliations and audits.
Assists with initial credentialing, additional location requests (office-adds) and recredentialing as needed.
Completes monthly state Medicaid verifications for all dentists.
Saves and enters welcome letters upon receipt into specialized internal database.
Maintain credentialing and insurance carrier electronic folders and files.
Respond to carrier requests received via email and phone.
Properly link dentists and hygienists in EagleSoft.
Prepare, print and submit existing provider re-credentialing applications to the insurance carriers for all employee dentists.
Complete delegated re-credentialing for all active dentists prior to the 3-year re-credentialing cycle cutoff date.
Responsible for all expired credentials including: Dental Licenses, DEA, Controlled Substance, Sedation Anesthesia Permits, Malpractice, and CPR cards.
Partner with field office managers to resolve status requests and credentialing related claims issues.
Other duties and special projects as assigned.