The Credentialing and Provider Enrollment Manager is responsible for all aspects of the credentialing, re-credentialing and privileging process for dental providers in a multiple practice organization. Negotiates network contracts with various insurance plans.
Summary of Essential Job Functions:
- Manage and administer the software for tracking and maintaining provider and insurance data.
- Completes provider credentialing and re-credentialing applications; monitors applications and follow-up as needed including certificate expirations and renewals
- Manage a team of Credentialing and Provider Enrollment Specialists
- Compiles and maintains current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
- Keep current on all dental plans and agency requirements for credentialing providers
- Ensure cohesive and concise communication with providers, offices, and shared teams to ensure that billing and scheduling occurs with in-network plans.
- Exceptional communication skills verbal and written
- Excellent ability to prioritize and problem solve
- Excellent interpersonal skills to work with providers and insurance representatives
- Well organized and proven attention to detail
Education: Bachelors degree or equivalent experience
Experience: 4+ years of experience in credentialing and provider enrollment
Computer Skills: Computer Literate
Language Ability: Excellent verbal and written communication skills including the ability to remain calm during stressful customer or employee situations. Bilingual preferred but not required
Work Environment/ Physical Demands:
The work environment includes work within a dental clinic and remote work in an office environment. The work environment may vary significantly and may include loud, fast-paced, and rapidly changing conditions. All employees working within a dental clinic have potential exposure to blood or air borne pathogens, as is typical in a healthcare setting. Position may require long periods of sitting and standing. Manual dexterity will be required for handling small objects. Close and distance vision will be required and the ability to shift focus rapidly. Nature of work requires an ability to effectively communicate and exchange information with patients, their parents, and staff.? Must be able to walk and stand for extended periods of time; ability to lift/carry up to 30 pounds and be able to twist, turn, bend and stoop.