<p>Job Purpose:</p> <p>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.</p> <p>Duties and Responsibilities:</p> <ul> <li>Reconcile monthly, weekly and biweekly extracts from contracted insurance carriers to ensure accuracy of provider demographic information and credentialing status. </li><li>Completes network accuracy reconciliations and audits. </li><li>Assists with initial credentialing, additional location requests (office-adds) and recredentialing as needed. </li><li>Completes monthly state Medicaid verifications for all dentists. </li><li>Saves and enters welcome letters upon receipt into specialized internal database. </li><li>Maintain credentialing and insurance carrier electronic folders and files. </li><li>Respond to carrier requests received via email and phone. </li><li>Properly link dentists and hygienists in EagleSoft. </li><li>Prepare, print and submit existing provider re-credentialing applications to the insurance carriers for all employee dentists. </li><li>Complete delegated re-credentialing for all active dentists prior to the 3-year re-credentialing cycle cutoff date. </li><li>Responsible for all expired credentials including: Dental Licenses, DEA, Controlled Substance, Sedation Anesthesia Permits, Malpractice, and CPR cards. </li><li>Partner with field office managers to resolve status requests and credentialing related claims issues. </li><li>Other duties and special projects as assigned. </li></ul> <p>Knowledge, Skills and Abilities:</p> <ul> <li>Provider credentialing or dental insurance experience a plus. </li><li>Advanced MS Outlook, Word and Excel. </li><li>Ability to multi-task and manage several projects at one time. </li><li>Ability to work in a fast-paced environment. </li><li>Ability to handle sensitive information and maintain confidentiality. </li><li>Ability to work independently and in a team environment. </li></ul>