Provider Administration Specialist

Provider Information Integrity Specialist

This position is responsible for maintaining the integrity of provider information on enterprise systems including overseeing the distribution of updated information requested by dental offices. Other responsibilities include assisting in nurturing positive relationships between the health plan, providers and practice managers.

Essential Duties & Responsibilities

• Maintains the integrity of an electronic database and assists dental providers offices with business name changes, tax ID changes, termination of dental contracts, change of ownership, business splits, sale of practices, adding additional associates, license changes, dental specialty changes, updated contract information, and provider directory assistance.
• Plan, prioritize, organize and complete work to meet established objectives.
• Work individually or with a team to solve complex problems related to provider servicing.
• Sometimes acts as a technical resource to others in own function.
• Works various workflow queues for claims where address tax identification number conflicts with the provider file data.
• Handles escalated calls from client groups as well as outgoing calls to dental offices.
• Resolves 1099 tax discrepancies with provider offices; verifying with external databases.
• Runs queries; generates monthly reports and credentialing document verification requests.
• Screens provider enrollment packets for missing information and requests missing information from the provider.
• Performs other miscellaneous duties as assigned.

Base Pay Information

The national base pay range below is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dentals assessment of the candidates knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity. $35,360 - $66,500

Core competencies / knowledge & skill requirements

• Organizational/time management skills and multi-tasking abilities.
• Strong written, verbal, interpersonal and phone skills
• Detail oriented with mathematical, reading, and comprehension skills.
• Knowledge of Current Dental Terminology (CDT) codes and dental nomenclature
• Ability to type 40 words per minute with no more than two errors.
• Knowledge of the companys claims processing systems, claims flows and adjustment notices.
• Must be flexible to work any shift and willing to work overtime as needed based on business needs.

Education, experience & training required

• A high school diploma or GED but candidates with proven experience will not be excluded from consideration.
• A minimum of 2 years related experience (Managed Care or Medical/Dental Insurance experience).

Communication & interpersonal skills

Written:*Ability to clearly present written information and findings.*Must be able to understand fairly complex written and oral instructions.

Verbal:* Ability to communicate concepts clearly to gain a collaborative understanding from those involved in the discussion.* Strong telephone skills.

Interpersonal:* The ability to interact well with co-workers and outside contacts.