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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.



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