Provider Enroll & Credentialing Support Specialist, DentaQuest

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

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 support US flexible working arrangements in the contiguous 48 states.

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:

The Provider Enrollment and Credentialing Specialist reviews all aspects of the Initial/ Re-Apply Credentialing, Re-credentialing, privileging and overseeing the onboarding process for all incoming providers. Primary responsibilities include verifying all the credentialing criteria for practitioners that have applied to the network, including follow up with practitioners as needed to obtain information

How you will contribute:

• Verify potential and existing provider’s 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.

• Assist with scheduling site reviews.

• Enroll the provider into payment system – Windward.

• Enter all provider information into credentialing database – Cactus.

• Maintain the integrity of the provider information in Windward and Cactus.

• Ensures credentialing file is in order with any issues flagged for committee.

• Meet required turnaround time and accuracy rate.

• Assist with other duties as assigned.

• 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.

• Other duties as needed or required.

What you will bring with you:

• High School Diploma or equivalent.

• 1 year job related experience

• Previous experience working with files or the collection and coordination of data preferred.

• Knowledge of Dental terminology preferred.

• Good interpersonal skills.

• Ability to work independently.

• Excellent oral and written communication skills.

• Efficient PC skills (Word, Excel, Outlook, Work Flow Software, Time Tracking Systems).

• Ability to learn new software programs quickly.

• Ability to prioritize and organize multiple tasks.

• Ability to remain organized with multiple interruptions.

• Good customer service and problem resolution skills.

• Ability to navigate websites needed for credentialing purposes.

• Ability to adapt to a constantly changing environment.

• Ability to work in excess of 40 hours in a week.

• Required to attend additional training as requested/deemed necessary.

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.

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