Credentialing and Enrollment Specialist
Credentialing and Enrollment Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
Dental Care Alliances mission is to advance the practice of dentistry by partnering with and supporting dental professionals to create a lifetime of healthy smiles. Headquartered in Sarasota Florida DCA currently supports over 400 allied practices and supports over 900 dentists across over 20 States. DCAs allied practices represent all dental specialties and treat patients under more than 150 brand names.
The Credentialing and Enrollment will report to the Senior Manager of Credentialing and Enrollment to manage the credentialing process for all providers within the organization within their territory. This role is critical in ensuring that all providers are properly credentialed with insurance payors and maintain compliance with regulatory standards.
Responsibilities
Execution of Credentialing Process: Execute nondelegated credentialing process for new and existing providers ensuring timely and accurate completion of all credentialing and recredentialing applications.
Insurance Payor Relationships: Serve as a point of contact for all insurance payor relationships managing communications and resolving any issues related to provider credentialing.
Compliance: Ensure that all credentialing activities comply with state federal and organizational regulations and standards.
Documentation: Maintain accurate and uptodate records of all credentialing activities including applications approvals and renewals.
Collaboration: Lead and mentor a team of credentialing specialists providing guidance and support to ensure high performance and professional development.
Problem Resolution: Address and resolve any issues or discrepancies that arise during the credentialing process.
Reporting: Generate and analyze reports on credentialing activities identifying trends and areas for improvement.
Core Competencies
Industry Knowledge: Indepth understanding of dental insurance industry practices regulations and trends including a broad understanding of billing and cash collection nuances to maximize insurance payments and benefits.
Analytical Skills: Strong analytical and problemsolving abilities to interpret insurance data identify trends make informed decisions based on information provided by DCAs credentialing SAAS reports
Execution Experience: Proven track record in collaborating with highperforming teams to achieve operational goals.
Expectations
Collaboration: Work closely with crossfunctional teams including revenue cycle operations and clinical leadership to align insurance plan management strategies with overall organizational goals.
Continuous Improvement: Identify opportunities for process improvements technology implementation and innovation to enhance insurance plan management practices within the DSO.
Qualifications
Direct experience 3 years or more working in a dental environment
Ability to travel up to 5%
Ability to work remotely
Required Experience:
Unclear Seniority
Employment Type
Full-Time
