Dental Credentialing Coordinator

Location:

HRI Dental

Department:

Health Services

Weekly Hours:

0

Status:

Per Diem

Shift:

Days (United States of America)

Job Summary:

ACCOUNTABILITIES

*All duties listed below are essential unless noted otherwise*

• Gathers, verifies, tracks, and maintains an audit trail of elements outlined in the Plan's credentialing and re-credentialing policy and procedures to include liaison activities with primary sources for new or established Dentist.
• Provides administrative support in the area of credentialing and re-credentialing to include accurately typed correspondence and reports, regarding provider applications.
• Maintains a working knowledge of the credentialing and re-credentialing process and other standards.
• Communicate with Dental Review Team when needed to gather their expert opinion on an application for credentialing.
• Management of provider contracts.
• Fee schedule management.
• Ensures that Dentist files are maintained with current information on licensure, DEA certificates, malpractice insurance coverage, malpractice claims experience, and other pertinent data, including the National Practitioner Data Bank reporting requirements.
• Run provider adequacy reports and accessibility reports on quarterly basis.
• Maintain provider directories (Commercial and Medicare).
• Upload provider directories for Medicare and Health Plans monthly.
• Complete network verification as necessary to meet state requirements.
• Complete any provider updates in the system; send notification of completion to provider.
• Provide support to accounting with TIN verification as necessary.
• Process member letters regarding a provider term.
• Be a direct contact for provider offices needing verification and any additional information as requested.
• Be the main contact for our leased networks with GEHA (request reports and provider data).
• Complete GEHA Compliance quarterly outreach.
• Point of contact for dental offices when Dental Network Reps are out in the field.
• Marketing support for projects with dental offices. 
• Assist in report generation for department.

REQUIRED QUALIFICATIONS

Education: High School Diploma or GED required.

Skills:

• Excellent computer skills, including Word and Excel or similar software.

• Must have excellent interpersonal skills necessary to communicate effectively with callers, physicians and offices.

• Strong customer service orientation and interpersonal skills for positive relationship building.

• Must possess good organizational and priority setting skills and exercise independent judgment with minimal guidance and supervision.

• Self motivated and directed with the ability to effectively prioritize and execute tasks in a high pressure environment.

• Team oriented within the Operations area in order to maintain a collaborative environment for problem solving.

Years of Experience: One to two years experience in telephone-based customer service preferred.

License: N/A

Certification: N/A

PREFERRED QUALIFICATIONS

Education: Associates degree.

Skills: 

• Strong knowledge base of dental billing office practices, including practice management computer system experience preferred.
• Demonstrate knowledge of ADA/CDT coding regulations and requirements preferred.
• Basic knowledge of insurance regulations.

Years of Experience: N/A

License: N/A

Certification: N/A

WORKING CONDITIONS

Personal Protective Equipment: N/A

Physical Demands: Sitting for extended periods of time.  Dexterity of hands and fingers to operate a computer keyboard, mouse, and phone for data entry.

The above list of accountabilities is intended to describe the general nature and level of work performed by the positions; it should not be considered exhaustive.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or other status protected by applicable law.

Equal Opportunity Employer/Drug-Free Workplace

ProMedica is a mission-driven, not-for-profit health care organization headquartered in Toledo, Ohio. It serves communities across nine states and provides a range of services, including acute and ambulatory care, a dental plan, and academic business lines. ProMedica owns and operates 10 hospitals and has an affiliated interest in one additional hospital. The organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges. Committed to its mission of improving health and well-being, ProMedica has received national recognition for its clinical excellence and its initiatives to address social determinants of health. For more information about ProMedica, please visit promedica.org/aboutus. 

Benefits:

We provide flexible benefits that include compensation and programs to help you take care of your family, your finances and your personal well-being. It’s what makes us one of the best places to work, and helps our employees live and work to their fullest potential.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace