* Screens provider credentialing and re-credentialing packets for missing information; requests missing information from provider; resolves discrepancies between information supplied and findings of other sources (State Dental or etc.);
* Creates and updates provider information in the credentialing system to ensure that credentials are completed within a timely manner and at a high level of accuracy.
* Receives provider inquiries via phone and correspondence. Researches and verifies detailed information on provider participation status. Perform verification of all applicable credentials.
* Contact providers for missing and expired information.
* Processing mail; incoming and outgoing.
* Performs miscellaneous duties as assigned.
Skills/Experience:
Job Requirements:
* A high school diploma or GED is preferred, but candidates with proven experience will not be excluded from consideration.
* A minimum of 2 years related experience.
* Knowledge of Delta Dental products, policies and terms of provider participation in various networks is expected at conclusion of training and any applicable probationary period.
* Ability to maintain confidentiality of providers information.
* Demonstrated understanding of basic corporate structures and how to accurately translate information provided on contracts, credentialing attestations and other sources to maintain provider records.
* Math skills to compile and validate statistical computations, reconcile discrepancies, and insure the validity and accuracy of results.
* Knowledge and application of English grammar including composition, editing and proofreading skills.
* Basic organizational/time management and project management skills and multi-tasking abilities.
* Detail oriented with analytical and problem solving skills. Knowledge of health care industry issues preferred.
* Ability to accurately enter relevant information into the credentialing system and other ancillary data repositories as needed.
* Must be able to understand fairly complex written and oral instructions.
* Ability to clearly present written information and findings. Ability to communicate concepts.
* Ability to interact well with co-workers and outside contacts.
* PC literacy; MSOffice skills (competency in Word, advanced skill in Excel, Access and other database applications).
* Regularly required to work standard office equipment (personal computer, photocopy machine, fax machine, etc.).
* Ability to work on a computer up to 7 hours a day.
* Regularly required to sit for long periods of time, and occasionally stand and walk.
* Regularly required to use hands to operate computer and other office equipment.
* Close vision required for computer usage. Occasionally required to stoop, kneel, climb and lift up to 25 pounds.
Required Skills:
Shift: 8:00am-4:45pm EST (could start as late as 9am if needed)
Resource will be working off of their own personal equipment. (no MacBook/no Chromebook)
Resource must be local to the Alpharetta, GA or Camp Hill, PA office. Though the role is remote, the is a potential opportunity to go onsite at a future time.
Notes on what the Manager is looking for in the applicants experience:
- High attention to detail working in a production environment
- Strong data entry skills
- Must have experience working in the healthcare/dental/insurance industry
- Resource MUST have two monitors to be successful in this position
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