DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.
Job Description:
Location: We welcome applicants from anywhere in the U.S.
At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.
The opportunity: Provider Enrollment and Credentialing Specialist understands and executes all aspects of the Initial/ Re-Apply Credentialing, Re-credentialing, privileging and the onboarding process for all incoming providers.
How you will contribute:
- Verify potential and existing providers licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification.
- Review National Practitioners Data Bank for adverse charges pending or filed against Provider.
- Review federal and/ or state OIG and SAM report for exclusion from the Medicaid or Medicare program.
- Review state Medicare OPT Out report for exclusion from the Medicare program.
- Monitors and reports provider complaints and utilization management reports
- Enter all provider information into credentialing database.
- Maintain the integrity of the provider information in credentialing database
- Ensures credentialing file is in order with any issues flagged for committee.
- Meet required turnaround time and accuracy rate. Coordinate and complete special projects as needed.
- Assist management in the implementation of department process improvements.
- Assist with the ongoing NCQA certification activities.
- Represent DentaQuest in a professional manner at all times while communicating with internal and external requestors. Maintains confidentiality of the credentialing information.
- Ability to independently, accurately, and timely resolve credentialing issues presented by an external or internal customers.
- Collaborate with the team to identify opportunities for improvement both within the department and interdepartmental. Assist in resolving escalated provider set up issues.
- Other duties as needed or required.
What you will bring with you:
- Associate degree or equivalent experience required.
- 2 years related experience.
Preferred skills
- Proficient using department software (Credentialing and Enrollment Systems, Word, Excel, Outlook, Work Flow Software, Time Tracking Systems).
- Ability to work independently.
- Excellent oral and written communication skills.
- Strong interpersonal skills.
- Ability to prioritize and organize multiple tasks.
- Ability to remain organized with multiple interruptions.
- Excellent customer service and problem resolution skills.
Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.
Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!
Life is brighter when you work at Sun Life
- Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
- Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
- A flexible work environment with a friendly, caring, collaborative and inclusive culture
- Great Place to Work® Certified in Canada and the U.S.
- Named as a “Top 10” employer by the Boston Globe’s “Top Places to Work” two years running
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
If you are a California resident, the salary range for this position is:
- Southern region: $39,300-$53,000 annually.
- Central region: $41,400-$59,900 annually
- Northern region: $44,300-$59,800 annually.
If you are a Colorado resident, the salary range for this position is $37,500-$50,600 annually.
If you are a New York resident, the salary range for this position is $44,300-$59,800 annually.
If you are Washington resident, the salary range for this position is $41,400-$59,900 annually.