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Credentialing Specialist - Full-Time In Irvine, CA

Smile Brands Inc.

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Overview

Smile Brands, a three-time Glassdoor Best Place to Work, is seeking a Credentialing Specialist to join our team! This position provides dental plan credentialing, enrollment and related support to the Operations Group by performing a board range of duties that includes completing contracting/credentialing paperwork, monitoring the contract process and reporting process, monitoring licensure, performing follow-up with plans and internal customers, completing W-9 forms, as well as completing various reports.


Essential Duties and Responsibilities

  • Load provider, facility and plan information onto various databases quickly and accurately
  • Update, maintain and make available the status information on databases on a daily basis
  • Review plan web-sites for provider and/or facility enrollment approvals
  • Serve as the liaison and maintain open communication with dental office staff, internal departments and company representatives
  • Maintain library of plan information and business rules
  • Take ownership of plan reporting, ensuring timeliness, completeness, accuracy and serve as the liaison to dental plans on behalf of the dental offices, obtain provider and/or facility enrollment approvals, discuss issues and process improvement
  • Review, research and report on adverse provider application responses
  • Monitor licensure/credentials for expiration dates, ensuring there is no lapse in licensure, by communicating with Dr.’s, Office Managers, Field reps and Management; completing all necessary follow-up
  • Maintain library of Dr.’s credentials, add new Dr.’s, (GPs and Specialty) to locations within markets
  • Review applications, prepare verification, update and maintain all related databases
  • Create any attachments/exhibits that may be required for applications or contracts
  • Process contracts/ applications with all appropriate dental plans for new and existing offices, ensuring completeness, timeliness and accuracy
  • Process new Doctors credentialing - obtain and review credentials and as necessary background checks
  • Continually review the credentialing and contracting processes to ensure compliance; decide if a process should be stopped and brought to the attention of Supervisor and Director before proceeding
  • Research billing/contacting questions received from plans, offices and/or billing offices
  • Maintain “Provider Number” spreadsheet on common drive for company reference
  • Process terminations, notify dental plans of terminations and locations changes, as well as PC, DBA and TIN changes, process all necessary paperwork, initial and recredentialing
  • Meet with Doctors in person (whenever necessary) and be prepared to answer all questions they may have regarding contracting/credentialing process
  • Process routine re-credentialing requests to include providing current documents and current attestation statements; complete monthly access survey requests
  • Complete oversight audits as required

Responsibilities

What we need from you:

  • 2 or more years of administrative experience in related field
  • Data Entry experience
  • Office Suite & Excel experience
  • Pays attention to detail
  • Highly motivated professional


    What We’ll Offer You

    • Unparalleled support to grow your career
    • We are willing to train
    • A culture that celebrates success and diversity
    • Benefits and perks for you, your family and even your pets!
    • Medical (including HSA and FSA), Dental, Vision, 401K, and paid time off for applicable full-time positions

    Smile Brands Inc. and all relevant Affiliates are Equal Opportunity Employers. We are proud to celebrate diversity and provide an inclusive workplace for all employees.

    DISCLAIMER: Please be aware of suspicious recruiting emails and text messages scams that attempt to collect your personal information. You will never be asked for your driver license or Social Security number during an online interview. Additionally, we do not attempt to collect money, gift cards or request you to purchase equipment on behalf of the company.



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