Provider Enrollment & Credentialing Support Specialist, DentaQuest (Iowa)

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Job Description:

Candidate must live in the State of Iowa.

JOB SUMMARY:

Primary responsibilities include receiving provider credentialing documents, pre-screening for completeness, scanning and re-routing. This permits accurate and timely processing of credentialing documents. This role also includes reviewing, scanning, filing and coordinating the execution of provider agreements. The intake review specialist will also enter provider data pertaining to applications, contract information, status changes, and payee changes.

PRIMARY JOB RESPONSIBILITIES:

• Electronically review assigned faxes and emails daily.
• Receive assigned mail relating to provider enrollment daily and turn electronic.
• Process assigned provider enrollment documents daily.
• Re-direct non-credentialing documents daily.
• Stamp all enrollment documents assigned daily.
• Conduct review of assigned provider enrollment documents daily.
• Research for active records in enterprise system.
• Enter or update existing provider records in enterprise system.
• Conduct review of assigned provider enrollment documents daily.
• Work with providers by phone, fax, U.S. mail, and email to ensure that they complete the enrollment process.
• Follow up with providers to ensure that all necessary information is received, and that the enrollment process is completed timely.
• Develop relationships with providers and their staff and answer questions they may have about the process.
• Coordinate scanning of documents and store electronically to Cactus credentialing software.
• Track daily intake volumes.
• Audit provider contract effective dates for execution.
• Coordinate contract execution.
• Scan provider contracts.
• Electronically file provider contracts.
• Research and correct data to avoid duplicate provider, locations or payees.
• Other duties as needed or required.

JOB QUALIFICATIONS:

Required:

• High School diploma or equivalent, Associate’s degree preferred.
• 1-3 years of experience in business environment.
• Proficient in the use of Excel.
• Proficient in general computer software (Word, Outlook, PowerPoint).
• Excellent customer service skills.
• Excellent verbal and written communication skills.
• Ability to learn new software programs quickly.
• Ability to create status reports on metrics.
• Ability to analyze data to determine next steps.
• Ability to prioritize and organize multiple tasks.
• Ability to remain organized amid multiple interruptions.
• Ability to work in a fast-paced environment.
• Ability to make independent decisions.
• Attention to detail.
• Ability to adapt to constantly changing environment.
• Ability to work in excess of 40 hours.

Preferred:

• Experience in credentialing preferred.
• Proficiency in the use of Cactus credentialing software preferred.

Physical Demands:

• Ability to sit at a computer for extended periods of time.
• Requires the use of office equipment including, telephone, computers, printers, scanners and fax machines.
• The position is located in a wheelchair accessible building.

The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform this position.

** In accordance with DentaQuest’s Compliance Plan, employee must conduct DQ business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or DQ’s Compliance Officer. **

DentaQuest’s Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program.

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [email protected] to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

Job Category:

Posting End Date:

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran