Insurance Credentialing Specialist

Company: Pediatric Dental Center Of Gardens
Location: Miami
Posted on: January 27, 2023

Job Description:

Job DescriptionPosition SummaryThe Insurance Credentialing Associate is responsible for maintaining active status for all providers by successfully completing initial and subsequent insurance credentialing as required by commercial payers, Private Insurances and Medicaid, per general guidelines, ensuring compliance with internal policies and external regulatory agencies.Education/Experience

• High school diploma or equivalent required
• One (1) year related experience (insurance credentialing, insurance billing, mental health/behavioral health setting, and/or medical office setting) required
• Electronic Health Record (EHR) experience helpful
• Must demonstrate the ability to work in Google Apps (Gmail, Docs, Sheets, Slides)
• Knowledge of Medicaid, Medicare, etc. highly preferredDuties Include:
  • Major Duties and Responsibilities:
    • Initiate and maintain credentialing for all locations
    • Communicate adverse, incomplete, or questionable data to designees and recommend appropriate course of action.
    • Initiate and maintain payor enrollment.
    • Prepare initial credentialing and re-credentialing files to be presented to the C.O.O in a timely and expeditious manner
    • Initiate and maintain provider services payor enrollment as assigned
    • Ensure accuracy and completeness of provider services applications whether state or private
    • Provide regular updates to the payors of changes in billable provider demographics, practice locations, name changes, etc.
    • Maintain accurate and concurrent updates for each location to reflect the history of a organization's credentialing and enrollment status
    • Resolve complex issues relating to provider credentialing
    • Respond to requests by external and internal entities regarding issues pertaining to the status of credentialing and/or enrollment of organization.
    • Prepare for re-credentialing applications on all services and locations
    • Other duties upon request
    • KNOWLEDGE, SKILLS AND ABILITIES
      • Comprehensive knowledge of medical, clinical, and payor (both commercial and managed care) credentialing regulations and process
      • Strong organizational skills, detail-orientation with the ability to prioritize
      • Time management skills in a fast-paced environment
      • Excellent Analytical skills to problem solving
      • Strong communication both written and verbal
      • Problem solving skills and ability to explore all options and use available resources to find new and effective solutions
      • Strong organizational, critical thinking and problem-solving skills required
      • Ability to communicate appropriately and effectively with providers; including sensitive and confidential information
      • Must be able to prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements
      • Exhibits sound judgment and one who hold themselves up as a role model and mentorInsurance Credentialing Specialistby Jobble

Keywords: Pediatric Dental Center Of Gardens, Miami , Insurance Credentialing Specialist, Other , Miami, Florida