Credentialing specialist Jobs in Lewisville, TX

PROVIDER CREDENTIALING &RECREDENTIALING & ENROLLMENTS :

Obtaining, verifying, entering, and storing provider credentials within established timeframes and quality standards.

• Ensuring required credentials are received for initial credentialing and re-credentialing.
• Save credentials in established folders and uploading into Verity Stream(Credential Stream) as appropriate.
• Data-enter credentials, payers, payer effective dates, and other pertinent information, as appropriate.
• Identify and forward to appropriate Coordinators items that need their attention.
• Enrolling providers to the appropriate insurers.
• Actively working to receive and document status and effective dates in Verity Stream (Credential Stream), Monday Board software, Issue Trak (ticketing system used internally), and other tools / software, as needed.
• Responding to re-credentialing requests with required credentials per payer.
• Store welcome letters / emails in the appropriate folder and upload into Verity Stream(Credential Stream) for each payer entry.
• Monitor and update Monday Boards, Issue Track, and Provider Rosters related to credentialing or enrollment without being asked.
• Notify offices of effective dates from each payer (forward welcome letters / emails or advise them directly from you).

CUSTOMER SERVICE / TROUBLESHOOTING :

Working interdepartmentally and externally to address issues with provider set-up, EOB research, and related information.

Determine if there’s an issue with the provider’s network status with the payer versus what’s in Verity Stream (Credential Stream) and showing at the office’s PMS system.

Actively help others troubleshoot issues, especially where you may have some additional knowledge (e.g., an office was previously owned by you).

PARTNERING WITH OFFICES / PROVIDERS :

Demonstrate a sense of ownership and pride in working with your assigned offices to facilitate a positive impact in working with the credentialing department.

FEE SCHEDULE MAINTENANCE :

Working interdepartmentally and externally to ensure appropriate fee schedule attachment (to provider records with payers) and updating into office practice management systems.

REQUIREMENTS :

Dental or health experience is a plus, but it is not required.

MB2 Dental Solutions, LLC is an equal opportunity employer.