Credentialing Coordinator

Credentialing Specialist

JOB OVERVIEW Responsible for all aspects of the credentialing and re-credentialing processes for all providers who provide patient care for the Smile Programs. Responsible for ensuring providers are credentialed with health plans. Maintain up-to date for each provider in credentialing databases and online systems; ensuring timely renewal of licenses and certifications.

Job Duties

• Compiles and maintains current and accurate date for all providers
• Completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed
• Maintains copies of current state licenses, DEA certificates, malpractice coverage, and any other required credentialing documents for all providers
• Maintains knowledge of current health plan and agency requirements for credentialing providers
• Maintains information in credentialing database
• Managing relationships between insurance companies and nation-wide dental services organization (DSO)
• Articulate DSO priorities to other stake holders through email, phone or other communication tools
• Build relationships through email and phone with colleagues across the country to ensure collaborative success
• Utilize online portals, web-based platforms or other technology to achieve company’s success
• Communicate complex messages efficiently through email.
  
  
  

ADDITIONAL RESPONSIBILITIES

• Maintains confidentiality of provider information
• Provides credentialing and privileging verification
• Performs other duties as assigned
  
  
  

SKILLS

• Knowledge and understanding of the credentialing process
• Ability to organize and prioritize work and manage multiple priorities
• Excellent verbal and written communication skills including letters, memos, and emails
• Excellent attention to detail
• Ability to research and analyze data
• Ability to work independently with minimal supervision
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization
• Proficient use of Microsoft Office applications (Word, Excel, Access) and Internet resources
  
  
  

Job Type Full-time

Required license or certification

• Driver's License
  
  
  

Required education

• High school or equivalent