Interdent Service Corporation
Credentialing Specialist Job in Ridgefield, WA
is responsible for organizing, maintaining, and verifying all aspects of the credentialing process for our dental practitioners in the clinics. In all activities, they must comply with all legal and regulatory policies and procedures.
The right candidate for this position will have a positive attitude, excellent clerical skills, be well organized, work well in a fast paced environment, be flexible, and adapt well to frequent changes.
Essential Duties and Responsibilities:
Credentialing new doctors with insurance plans, which includes:
Submitting appropriate application to each insurance plan, include all required Dr credentials
Tracking the insurance applications throughout the credentialing process, from sending to and from the doctor, to the insurance companies and follow up until all insurance applications have been processed and the doctor is accepted by all plans.
Maintaining an insurance grid for each region, listing the acceptance dates for every plan for which the provider has been accepted. Sending updated grids out weekly to the field.
Maintaining and tracking State Dental License, DEA, CPR and Malpractice Insurance records for all doctors within the regions they support. Communicate to Practice Managers, Directors of Operation, Area Clinical Directors and PC Owners prior to license documents expiring.
Managing new doctor paperwork, collecting/processing all information and keep in an organized file.
Monitoring the insurance company websites for accurate doctor/office information listings for all providers with all insurance plans.
Re-credentialing existing doctors with the insurance plans as requested by insurance companies.
Notifying all insurance companies when HR notifies us that a provider has left the practice. Remove termed providers from Active Intranet, Insurance Grids, Doctor Lists, Verifpoint. Scan and move all necessary documents from the dentist's chart to the Termed Dentist File in Credentialing folder.
Respond to insurance company requests for additional dentist information, W-9 requests, and directory audit requests.
Thorough understanding of dental billing practices and procedures, including knowledge of state, local and federal laws
Strong knowledge of reimbursement rules and methodologies for billing
Fluent in Excel, Word, Outlook, typing and number entry accuracy
Must have a high level of attention to detail and good proofreading skills
Must have excellent tracking and follow up skills
Able to prioritize and adapt to high pressure situations and frequent changes
Full time, Monday thru Friday
$17-22/hr depending on experience
Employee Assistance Program
Medical and pharmacy, dental, vision (for employees and their families)
Basic life, AD&D, and long-term disability insurance
6 Paid holidays and 1 Paid floating holiday
PTO (80 hours per year for hourly; 120 hours per year for salaried)
401k plan and deferred compensation plan
High School or better