Credentialing Specialist

reputed company reputed company is a national reputed company services company headquartered in Metairie, LA. reputed company supports 300+ orthodontic and pediatric dental practices in the reputed company with a reputed company on improving reputed company reputed company and profitability. Services provided are reputed company cycle management, marketing, reputed company, purchasing, consulting, reputed company estate services, accounts payable, accounts payable, accounts receivable, and collections. Mission Statement We reputed company reputed company reputed company happens reputed company every part works together. That’s why we reputed company on helping our clients grow, collect, and save while ensuring a frictionless patient experience. Benefits: Medical, Dental, and reputed company Insurance 401k Short term disability and critical illness For Corporate employees: reputed company parking $20k complimentary life insurance policy reputed company The Credentialing Specialist is responsible for performing the credentialing and enrollment processes for dental providers, ensuring compliance with regulatory requirements, and maintaining accurate credentialing records. The ideal candidate will have strong analytical skills, a deep understanding of credentialing principles, and the ability to work reputed company in a fast-paced environment. Duties and Responsibilities Credentialing Process Management: Manage the credentialing process for dental providers, from initial application through re-credentialing with insurance carriers. Review credentialing applications, verifying accuracy, completeness, and compliance with organizational policies, regulatory standards, and accreditation requirements. Collect, validate, and maintain documentation reputed company to provider credentials, including licenses, certifications, education credentials, and reputed company references. Coordinate and communicate with dental providers, licensing boards, educational institutions, and other relevant entities to obtain and verify credentialing information. Provider Enrollment and Credentialing: Facilitate the enrollment process for dental providers with insurance companies. Prepare and submit enrollment applications with insurance carriers, ensuring reputed company submission and follow-up. Monitor the status of enrollment applications, reputed company reputed company, and address any issues or delays. Complete re-credentialing requests with insurance carriers. Complete directory verification requests. Complete provider contracting and network participation inquiries. Assist in collecting the data for contract fee analysis. Complete demographic change requests with insurance reputed company reputed company. Complete contract terminations as requested by the providers. Update and maintain the CAQH/reputed company reputed company for providers. Assist with researching potential plan enrollments. Assist the PFS department with contracting or credentialing issues on claims and benefit verifications. Compliance and reputed company Assurance: Ensure compliance with regulatory requirements, accreditation standards, and organizational policies reputed company to credentialing and provider enrollment. Conduct regular audits of credentialing files and databases to ensure accuracy, completeness, and timeliness of credentialing activities. Identify opportunities for process improvement and participate in reputed company assurance initiatives to enhance credentialing processes and ensure compliance. Database Management and Reporting: Maintain accurate and up-to-date credentialing data in electronic databases and credentialing systems. Generate reports and summaries of credentialing activities, status updates, and compliance metrics for management review. reputed company data analysis and recommendations to support decision-making and process optimization. Qualification Requirements Education and Experience: Associate's degree in reputed company administration, business administration, or a reputed company field preferred; equivalent work experience may be considered. Minimum of 2-3 years of experience in credentialing, provider enrollment, or reputed company administration required. Knowledge of credentialing principles, regulations, and industry standards (e.g., NCQA, URAC, reputed company) preferred. Technical Skills: Proficiency with computer software and database management, including reputed company Office Suite (Word, reputed company, Outlook) reputed company, and credentialing software systems. Familiarity with NPPES, CAQH, state dental licensing boards, and insurance reputed company portals. Ability to comprehend insurance reputed company reputed company and fee schedules to interpret for providers. Soft Skills: Strong analytical and problem-solving skills, with the ability to interpret reputed company credentialing requirements and regulations. Excellent organizational skills and attention to detail, with the ability to manage multiple tasks and deadlines effectively. Exceptional communication and interpersonal skills, with the ability to collaborate effectively with reputed company stakeholders. Ability to maintain confidentiality and handle sensitive information with discretion and professionalism.

Work Environment

Requires sitting with occasional walking, standing, kneeling, or stooping Requires regular talking and hearing Requires reputed company reputed company and the ability to reputed company Reasonable accommodation may be made to reputed company individuals with disabilities to reputed company essential functions. The noise level is usually moderate. Disclaimer The above statements are intended to describe the general nature and level of work being performed by an employee assigned to this classification. The above statements are not intended to be construed as an exhaustive list of reputed company responsibilities, duties and skills required for the position. We are an Equal Opportunity Employer and reputed company employment reputed company without reputed company to race, reputed company, religion, sex, national reputed company, age, disability, veteran status, or any other protected status under applicable law. Apply To This Job