ProMedica
Dental Network Specialist - Services - Paramount
This job is now closed
Job Description
- Req#: 793281
- Gathers, verifies, tracks, and maintains an audit trail of elements outlined in the Plan's credentialing and re-credentialing policy and procedures to include liaison activities with primary sources for new or established Dentist.
- Provides administrative support in the area of credentialing and re-credentialing to include accurately typed correspondence and reports, regarding provider applications.
- Maintains a working knowledge of the credentialing and re-credentialing process and other standards.
- Communicate with Dental Review Team when needed to gather their expert opinion on an application for credentialing.
- Management of provider contracts.
- Fee schedule management.
- Ensures that Dentist files are maintained with current information on licensure, DEA certificates, malpractice insurance coverage, malpractice claims experience, and other pertinent data, including the National Practitioner Data Bank reporting requirements.
- Run provider adequacy reports and accessibility reports on quarterly basis.
- Maintain provider directories (Commercial and Medicare).
- Upload provider directories for Medicare and Health Plans monthly.
- Complete network verification as necessary to meet state requirements.
- Complete any provider updates in the system; send notification of completion to provider.
- Provide support to accounting with TIN verification as necessary.
- Process member letters regarding a provider term.
- Be a direct contact for provider offices needing verification and any additional information as requested.
- Be the main contact for our leased networks with GEHA (request reports and provider data).
- Complete GEHA Compliance quarterly outreach.
- Point of contact for dental offices when Dental Network Reps are out in the field.
- Marketing support for projects with dental offices.
- Assist in report generation for department.
- • Strong knowledge base of dental billing office practices, including practice management computer system experience preferred.
- • Demonstrate knowledge of ADA/CDT coding regulations and requirements preferred.
- • Basic knowledge of insurance regulations.
- • Strong knowledge base of dental billing office practices, including practice management computer system experience preferred.
- • Demonstrate knowledge of ADA/CDT coding regulations and requirements preferred.
- • Basic knowledge of insurance regulations.
Paramount Health Care, a ProMedica Health Plan, offers insurance products across six Midwest states. This Ohio-based company, headquartered in Toledo, has more than 685 employees dedicated to serving their health plan members.
Paramount offers Medicare Advantage and Marketplace Exchange health plans for individuals and families. Paramount maintains accreditation by the National Committee for Quality Assurance (NCQA) for their HMO and Medicare Advantage products.
In addition, Paramount has a full complement of insurance products for employers of any size, including medical, dental, vision and workers’ compensation, as well as vocational rehabilitation, life-care planning and wellness.
As a part of ProMedica, Paramount is driven by ProMedica’s mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount strives to provide an exceptional experience to every member. For more information about Paramount, please visit our website at paramounthealthcare.com.
REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES
Role will report to Dental Network and Product Manager. This position with have no direct reports.
POSITION SUMMARY
This position will coordinate the applications for initial credentialing and re-credentialing of network Dentist in accordance with our standards of and regulatory requirements. The Credentialing Specialist will also handle all applicable updates concerning network and manage all provider directories.
ACCOUNTABILITIES
*All duties listed below are essential unless noted otherwise*
REQUIRED QUALIFICATIONS
Education : High School Diploma or GED required.
Skills:
• Excellent computer skills, including Word and Excel or similar software.
• Must have excellent interpersonal skills necessary to communicate effectively with callers, physicians, and offices.
• Strong customer service orientation and interpersonal skills for positive relationship building.
• Must possess good organizational and priority setting skills and exercise independent judgment with minimal guidance and supervision.
• Self-motivated and directed with the ability to effectively prioritize and execute tasks in a high-pressure environment.
• Team oriented within the Operations area in order to maintain a collaborative environment for problem solving.
Years of Experience : One to two years’ experience in telephone-based customer service preferred.
License : N/A
Certification : N/A
PREFERRED QUALIFICATIONS
Education : Associates degree.
Skills:
Years of Experience : N/A
License : N/A
Certification : N/A
WORKING CONDITIONS
Personal Protective Equipment: N/A
Physical Demands: Sitting for extended periods of time. Dexterity of hands and fingers to operate a computer keyboard, mouse, and phone for data entry.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org
Equal Opportunity Employer/Drug-Free Workplace
REQUIRED QUALIFICATIONS
Education : High School Diploma or GED required.
Skills:
• Excellent computer skills, including Word and Excel or similar software.
• Must have excellent interpersonal skills necessary to communicate effectively with callers, physicians, and offices.
• Strong customer service orientation and interpersonal skills for positive relationship building.
• Must possess good organizational and priority setting skills and exercise independent judgment with minimal guidance and supervision.
• Self-motivated and directed with the ability to effectively prioritize and execute tasks in a high-pressure environment.
• Team oriented within the Operations area in order to maintain a collaborative environment for problem solving.
Years of Experience : One to two years’ experience in telephone-based customer service preferred.
License : N/A
Certification : N/A
PREFERRED QUALIFICATIONS
Education : Associates degree.
Skills:
Years of Experience : N/A
License : N/A
Certification : N/A
WORKING CONDITIONS
Personal Protective Equipment: N/A
Physical Demands: Sitting for extended periods of time. Dexterity of hands and fingers to operate a computer keyboard, mouse, and phone for data entry.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org
Equal Opportunity Employer/Drug-Free Workplace
About the company
ProMedica is a mission-based, not-for-profit integrated healthcare organization serving communities in 30 states.
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