<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>Essential 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>To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p> <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> <p>Qualifications (Experience, Education, Licensure, Certification)</p> <ul> <li>Credentialing experience, preferred </li></ul> <p>Working Conditions</p> <p>Credentialing Representative will work in areas that are highly visible and designed and furnished to make a good impression. Most work stations are clean, well lit, and relatively quiet. Work is primarily sedentary in nature.</p> <p>Limitations and Disclaimer</p> <p>The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.</p>