Credentialing Representative

This is a fully remote position, open to applicants in Alabama, +16 more states.

📋 Description

• Manage the submission and resubmission of provider applications, encompassing initial outreach, evaluation, and data entry.

• Oversee the maintenance of the provider database.

• Engage with providers via phone and email regarding the status and details of their credentialing.

• Execute credentialing, re-credentialing, and associated tasks.

• Coordinate the verification of credentialing.

• Analyze and manage intricate additions, modifications, and removals of provider data within the Dental Provider file database.

• Assist in the rollout of new networks, systems, software, guidelines, and other initiatives, with an emphasis on group practices.

• Train credentialing staff based on their experience level.

• Oversee credentialing inventory, reports, and projects to ensure adherence to set deadlines.

• Generate and distribute monthly reports.

• Address complex, unique, and high-level credentialing challenges.

• Provide support for projects, audits, business partners, internal teams, and external clients.

• Act as the department's subject matter expert.

• Conduct research and gather documentation for audits.

• Offer customer oversight for specific requirements and timelines.

• Investigate interim licensing actions, depending on the complexity involved.

• Engage in initiatives aimed at streamlining, automating, or enhancing credentialing processes.

⛳️ Requirements

• High School Diploma or GED.

• 3–5 years of relevant, progressive experience.

• Background in Provider Data Management, Customer Services, or Claims.

• Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint.

• Understanding of credentialing processes and URAC standards.

• Experience with ULTRA and Dental Provider File systems.

• Familiarity with Customer Service inquiry systems or claims processing principles.

• Strong written and verbal communication skills.

• Proficient in the use of provider files and provider credentialing.

• Demonstrated professionalism and diplomatic skills.

• Excellent written communication and presentation abilities.

• Adherence to HIPAA, data security protocols, company policies, and relevant laws and regulations.

🏝️ Benefits

• Competitive hourly wage ranging from $20.72 to $30.12.

• Flexible remote work options.

• No travel obligations.