Credentialing and Enrollment Specialist

Credentialing And Enrollment Specialist Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do. With over 2,000 employees in offices across the country, from clinical to support staff, we are united in our mission to create happy, healthy smiles through providing high-quality dental care in a fun, compassionate environment. Are you ready to join us in creating our next million smiles? We have JUST the opportunity for you. The Credentialing and Enrollment Specialist reports to the Manager of Credentialing and Enrollment and will be a key member of the Revenue Support Team. This role is primarily focused on ensuring timely, accurate and efficient credentialing and re-credentialing of all Benevis and Affiliated Entities, providers, and offices with contracted Medicaid and commercial insurance payors. The ideal candidate must a self-starter in addition to being comfortable collaborating across various departments within the organization. Responsibilities Processes credentialing and re-credentialing Medicaid and Commercial applications of dentists and tracks all progression steps in the internal database. Meets or exceeds individual productivity metrics, quality, and timeliness standards as defined by department guidelines. Review provider enrollment packets for missing information; request missing information from provider; resolve discrepancies between information supplied and findings of other sources (NPDB, State Dental Boards, etc.) Ability to accurately build provider records and to enter relevant information into the credentialing database and other ancillary data repositories as needed. Ensure the provider's credentials comply with requirements of contracted payers, as well as preparing providers files for the credentialing committee according to NCQA regulations. Maintains up-to-date physician database, including but not limited to medical licenses, Drug Enforcement Administration certificates, professional liability insurance, provider numbers, and renewal period expiration dates. Researches detailed information on provider status in response to telephone or written inquiries. Researches and analyzes problems with enrollment packets and recommends resolutions. Runs queries, generates reports, and performs credentialing document verification requests. Reviews correspondence received and performs appropriate action to resolve. Troubleshoots provider-related claims issues and works to resolve for Hold Provider claims for adjudication for in-network payments. Other duties and special projects as assigned Qualifications A minimum of 4 years of related healthcare experience with provider enrollment preferred in a high-volume environment in dental, medical, optometry, or medical staffing industries. Ability to organize, perform, and track multiple tasks accurately in short timeframes; able to work quickly and accurately in a fast-paced environment while managing multiple demands; able to work both independently and collaboratively as a team player; demonstrates adaptability, analytical and problem-solving skills, and attention to detail; and transcribe accurately Proficient in using the Microsoft Office software applications (Excel, Word, PowerPoint) Communicate effectively, both written and orally, with dentists, payers, and interdepartmentally Excellent organizational/time management and project management skills and multitasking abilities We Offer: Competitive compensation Comprehensive Benefits Package: Medical, Dental, Vision, 401K with match, flexible spending accounts, paid time off, company holidays and much more! We value teamwork, mutual respect and cooperation. We do not practice unlawful discrimination, including harassment or tolerate it in our workplace. What do we mean by discrimination? We mean that we do not discriminate on the basis of race, color, creed, religion, sex, national origin, age, citizenship, disability, sexual orientation or any other characteristic protected by federal, state, or local law.