Credentialing Coordinator

Location: Vancouver, WA
Date Posted: 07-10-2017
The Credentialing Coordinator is responsible for organizing, maintaining, and verifying all aspects of the credentialing process for
our dental practitioners in the clinics. In all activities, they must comply with all legal and regulatory policies and procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Credentialing new doctors with insurance plans, which includes:
    • Adding doctor information to a credentialing application data base
    • Filling out all insurance applications that the provider will participate with based on region and office(s)
    • Getting the applications ready and sending them to the doctor to sign
    • Checking for completeness when returned by the doctor
    • Submitting appropriate application to each insurance plan, include all required Dr credentials
    • Adding providers to spreadsheets for the delegated insurance plans
  • Tracking the insurance applications throughout the credentialing process, from sending to and from the doctor, to the insurance companies and follow up until all insurance applications have been processed and the doctor is accepted by all plans.
  • Maintaining an insurance grid for each region, listing the acceptance dates for every plan for which the provider has been accepted. Sending updated grids out weekly to the field.
  • Maintaining and tracking State Dental License, DEA, CPR and Malpractice Insurance records for all doctors within the regions they support. Communicate to Practice Managers, Directors of Operation, Area Clinical Directors and PC Owners prior to license documents expiring.
  • Managing new doctor paperwork, collecting/processing all information and keep in an organized file.
  • Monitoring the insurance company websites for accurate doctor/office information listings for all providers with all insurance plans.
  • Re-credentialing existing doctors with the insurance plans as requested by insurance companies.
  • Notifying all insurance companies when HR notifies us that a provider has left the practice. Remove termed providers from Active Intranet, Insurance Grids, Doctor Lists, Verifpoint. Scan and move all necessary documents from the dentist's chart to the Termed Dentist File in Credentialing folder.
  • Respond to insurance company requests for additional dentist information, W-9 requests, and directory audit requests.

KNOWLEDGE, SKILLS AND ABILITIES:
  • Thorough understanding of dental billing practices and procedures, including knowledge of state, local and federal laws
  • Strong knowledge of reimbursement rules and methodologies for billing

KEY COMPETENCIES:
  • Fluent in Excel, Word, Outlook, typing and number entry accuracy 
  • Must have a high level of attention to detail and good proofreading skills
  • Must have excellent tracking and follow up skills
  • Must maintain confidentially of all records
  • Able to prioritize and adapt to high pressure situations and frequent changes

EDUCATION / EXPERIENCE
  • Dental or Medical credentialing experience
or
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