- Reviews credentialing reports loaded into the administration system for accuracy
- Performs timely data entry of contract arrangements into administration system following credentialing.
- Updates and maintains contract and demographic changes ensuring accurate reporting, claims payment and directory information.
- Ensures timely follow-up is conducted to secure missing information. Generates letters to providers following contract or demographic maintenance.
- Meets or exceed departmental and individual metrics goal expectations as required by productivity and quality.
- Prepares documents for contract execution
- Processes adverse files including researching information with appropriate agencies.
- Prepares adverse reports for review by the Dental Credentialing Committee.
- Performs telephonic and written correspondence outreach to providers for any missing, expired or incomplete documentation.
- Report to office once every 8 weeks
- May perform other duties as assigned
Required Knowledge, Skills, and Abilities
- Knowledge in the health or dental insurance industry
- Excellent communication skills including the ability to address a wide range of audiences
- Customer service skills
- Basic MS Office skills
- Ability to read documents and extract information
- Ability to understand and evaluate contractual language
