This position is not remote.
ABOUT PEDIATRIC DENTAL SOLUTIONS
We are a growing pediatric dental and orthodontic practice that values integrity, honesty, and accountability. We are devoted to helping all children and teens achieve a lifetime of healthy smiles, ensuring they receive the highest quality of care. Using the latest techniques, our highly trained and experienced pediatric specialists provide outstanding dental and orthodontic care in a comfortable, kid-friendly setting. We offer services for fearful and anxious children as well as children with special needs.
PDS Management Services, LLC is looking to hire a full-time Provider Based Credentialing Specialist
This position earns $60,000 to $80,000/year depending on experience. We also offer medical insurance, flexible spending accounts (FSAs), a 401(k) plan, paid time off (PTO), Aflac, Sign-On and Referral Bonuses, and more.
Credentialing Specialist Qualifications
· High school diploma or equivalent
· Four years of relevant credentialing experience
· Responsible for updating excel spreadsheets for the Managed Care Plans
· Must be familiar with how different insurance companies operate and what documentation each company requires
· Responsible for Provider, Facility, and Location Credentialing and Enrollment
· Responsible for updating Provider, Location, and Facility demographics with various payers
· Responsible for maintaining and updating CAQH and NPPES
· Interpret complex payer regulations and resolve issues. Act as liaison with billers and other departments
· Directly responsible for routinely verifying credentialing and re-credentialing application status with insurance contacts for all physicians in Manage Care Companies
· Consistently completes all required work within the time frame requested
· Computer proficient in MS Office (Word, Excel, PowerPoint, & SharePoint)
· Internet savvy
· Experience with Credentialing Software and Credential My Doc is a plus
· Excellent communication skills
· Strong organization skills
Our staff is integral to our dentistry practice. In order to hire and retain the best career-minded individuals, we offer competitive pay, excellent benefits, opportunities for career development, and a positive work environment.
Credentialing Specialist Responsibilities:
· Excellent interpersonal, problem-solving, and verbal and written communication skills
· Ability to effectively convey information and collaborate with internal and external customers, including staff, health plan management, governmental agency personnel, provider panel program, and/or other applicable customers as assigned
· Experience and knowledge regarding insurance plans, coding, auditing, and contract compliance
· Demonstrated ability to perform the essential functions of the job as outlined in the job description
· Coordinates and maintains a system for receiving, processing, and resolving provider and member appeals and grievances following all applicable contract provisions, plan policies, procedures, rules, and regulations
· Manages the policy and procedures according to Federal and State regulations
· Analysis of trends for internal monitoring purposes and external reporting
· Manages the communication with the Medicaid, Medicaid CMOs, commercial insurance plan, or related program
· Manages turn-around times/response times
· Assessment and performance review and coordinating Medicaid audits with the appropriate internal staff, claims, customer service, provider credentialing, etc.
· Responsible for the contract deliverables and reports as outlined in the contracts
· Identifies compliance issues and implements corrective action plans
· Maintains program integrity in all areas and functions within the health plan; audits operational functions and internal processes audit pertaining to fraud, waste, and abuse, analysis of audits for quality improvement opportunities
· Additional responsibilities as assigned
Credentialing Specialist Benefits:
· $60,000 to $80,000 per year, depending on experience.
· Medical insurance
· Flexible spending accounts (FSAs), a 401(k) plan
· Paid time off (PTO),
· Aflac, and more.
· Sign-On Bonus
· Referral Bonus
Credentialing Specialist Work Schedule:
This full-time healthcare administrative customer service position typically works during our dentists' and orthodontists' regular hours of 9:00 AM - 5:00 PM, but hours vary. In office
Job Type: Full-time
Pay: $55,000.00 - $60,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Experience:
- Microsoft Office: 1 year (Preferred)
Work Location: In person