Hybrid Provider Enrollment & Credentialing Support Specialist

at Sun Life

• Job title: Provider Enrollment & Credentialing Support Specialist
• Job type: Full Time
• Experience level: Junior
• Salary: $40,600 - $54,800 per year
• Degree requirement: High School Diploma
• Location requirements: Hybrid, Des Moines, United States

About the role

• Provider Enrollment and Credentialing Specialist reviewing credentialing criteria for incoming providers at DentaQuest. Responsibilities include verification, enrollment, and compliance monitoring.

Responsibilities

• Candidate must reside in the state of Iowa
• Provider Enrollment and Credentialing Specialist reviews all aspects of the Initial/ Re-Apply Credentialing, Re-credentialing, privileging and overseeing the onboarding process for all incoming providers
• Primary responsibilities include verifying all the credentialing criteria for practitioners that have applied to the network, including follow up with practitioners as needed to obtain information
• Verify potential and existing provider’s licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification
• Contract Validation: Review contract and application for completeness
• Review National Practitioners Data Bank for adverse charges pending or filed against Provider
• Review federal and/ or state OIG and SAM report for exclusion from the Medicaid or Medicare program
• Review state Medicare OPT Out report for exclusion from the Medicare program
• Monitors and reports provider complaints and utilization management reports
• Assist with scheduling site reviews
• Enroll the provider into payment system – Windward
• Enter all provider information into credentialing database – Cactus
• Maintain the integrity of the provider information in Windward and Cactus
• Ensures credentialing file is in order with any issues flagged for committee
• Meet required turnaround time and accuracy rate
• Assist with other duties as assigned
• Assist management in the implementation of department process improvements
• Assist with the ongoing NCQA certification activities
• Represent DentaQuest in a professional manner at all times while communicating with internal and external requestors
• Maintains confidentiality of the credentialing information
• Other duties as needed or required

Requirements

• High School Diploma or equivalent
• 1 year job related experience
• Previous experience working with files or the collection and coordination of data preferred
• Knowledge of Dental terminology preferred
• Good interpersonal skills
• Ability to work independently
• Excellent oral and written communication skills
• Efficient PC skills (Word, Excel, Outlook, Work Flow Software, Time Tracking Systems)
• Ability to learn new software programs quickly
• Ability to prioritize and organize multiple tasks
• Ability to remain organized with multiple interruptions
• Good customer service and problem resolution skills
• Ability to navigate websites needed for credentialing purposes
• Ability to adapt to a constantly changing environment
• Ability to work in excess of 40 hours in a week
• Required to attend additional training as requested/deemed necessary

Benefits

• generous vacation and sick time
• market-leading paid family, parental and adoption leave
• medical coverage
• company paid life and AD&D insurance
• disability programs
• partially paid sabbatical program
• 401(k) employer match
• stock purchase options
• employer-funded retirement account
• flexible, inclusive and collaborative work environment that supports career growth