Credentialing Representative

Job Purpose:

The Credentialing Representative is responsible for maintaining all dentist professional licenses, enrolling new dental providers with all insurance plans, maintaining in-network privileges for existing dental providers and other duties related to dental provider credentialing.

Duties and Responsibilities:

• Reconcile monthly, weekly and biweekly extracts from contracted insurance carriers to ensure accuracy of provider demographic information and credentialing status.
• Completes network accuracy reconciliations and audits.
• Assists with initial credentialing, additional location requests (office-adds) and recredentialing as needed.
• Completes monthly state Medicaid verifications for all dentists.
• Saves and enters welcome letters upon receipt into specialized internal database.
• Maintain credentialing and insurance carrier electronic folders and files.
• Respond to carrier requests received via email and phone.
• Properly link dentists and hygienists in EagleSoft.
• Prepare, print and submit existing provider re-credentialing applications to the insurance carriers for all employee dentists.
• Complete delegated re-credentialing for all active dentists prior to the 3-year re-credentialing cycle cutoff date.
• Responsible for all expired credentials including: Dental Licenses, DEA, Controlled Substance, Sedation Anesthesia Permits, Malpractice, and CPR cards.
• Partner with field office managers to resolve status requests and credentialing related claims issues.
• Other duties and special projects as assigned.

Knowledge, Skills and Abilities:

• Provider credentialing or dental insurance experience a plus.
• Advanced MS Outlook, Word and Excel.
• Ability to multi-task and manage several projects at one time.
• Ability to work in a fast-paced environment.
• Ability to handle sensitive information and maintain confidentiality.
• Ability to work independently and in a team environment.