Credentialing Associate I
Description
State's leading dental and vision benefits provider, is seeking a Credentialing Associate to join our Credentialing team. In this role, you'll support the administration of dentist credentialing, recredentialing, and contracting processes while helping ensure compliance with state, federal, Medicare, Medicaid, and Arizona standards.
As a Credentialing Associate, you'll be responsible for maintaining accurate provider records, reviewing and processing credentialing and contract documentation, monitoring licensure and certification requirements, and supporting provider compliance activities. You'll serve as a key point of contact for dental offices and providers, responding to inquiries regarding contracts, credentialing, network participation, and related claims matters.
About You
You're the type of person who can spot a missing document from a mile away and actually enjoys keeping things organized. You thrive in a detail-driven environment, balancing provider credentialing, compliance requirements, and contract processes while delivering exceptional service to dental offices and internal partners.
You love solving problems, building relationships, and ensuring the details are accurate the first time. If you're highly organized, customer-focused, and enjoy keeping the wheels turning behind a strong provider network, you'll fit right in.
Sound like you? Keep reading, we’d love to tell you more!
Essential Duties
- Responsible for updating and maintaining the applicable provider file database(s) with documentation submitted.
- Prepare all incoming change request documents from the Dentist/Dental office as needed to complete the credentialing and contract process for the PR Associates; this may require a request of missing documents
- Respond to dental office inquiries regarding provider contracts, credentialing, and network participation.
- Answer and assist with all incoming calls and voice messages.
- Customer service to all internal and external callers.
- Monitor all inboxes; open and distribute all documents accordingly.
- Assist the Provider Relations team on projects or other related functions.
- Intake and review all returned W9 and 1099s, reaching out to offices to confirm/verify office information and forward to the appropriate personnel.
- Assist the Provider Relations team on projects, reports or other related functions.
- Achieve and maintain consistency in meeting quality and quantity standards.
- Create and maintain records of all provider information in electronic database files including credentialing documentation, network status, contracts, license and certification expirations, filed fees and contact updates for all networks.
- Identify and make updates and corrections to demographics as they are identified or as received from the provider in a timely manner.
- Responsible for updating and maintaining the applicable provider file database(s) with documentation submitted.
- Prepare all incoming change request documents from the Dentist/Dental office as needed to complete the credentialing and contract process, this may require a request of missing documents
- Responsible for maintaining the credentialing process for all network dentists per MA, Medicare and DDPA standards.
- Initial contract entry, ensuring we have acquired all appropriate documentation, provider and office information has been entered/updated accurately prior to entry. Verifying the flow of the updated information.
- Prepare and send letters and correspondence regarding network status, compliance requirements, dentist terminations, welcome letters, etc.
- Respond to dental office inquiries regarding provider contracts, credentialing, and network participation.
