40 hours per week
Monday – Friday – flexible hours
Work in the Hialeah Office or Hybrid schedule for the right candidate
Bilingual Only- English/Spanish
Credentialing Specialist (CPCS) certification is preferred
Our client has over 30 years in the industry of managing and growing a network of medical/dental clinics. They have engaged ttg Talent Solutions to search for their next Credentialing Specialist.
The Credentialing Specialist plays a critical role in ensuring the timely credentialing and re-credentialing of our dental providers. This role requires a motivated self-starter with excellent attention to detail and a sense of urgency in the completion of deadline-driven tasks. Must be highly organized and excellent at time management. This positon reports to the Revenue Cycle Manager.
- 6 years of as a Credentialing Specialist or similar experience
- Dental credentialing a plus
- Certified Provider Credentialing Specialist (CPCS) certification is preferred
- Medicaid experience and from other payors- preferred.
- Must be well-versed in Excel (data, reports, formulas, etc)
- Must be an expert MS office word
- Must be Bilingual – English and Spanish
Key Performance Indicators
- Credentialing Grid update counts (daily)
- Credentialing days per carrier & per provider
- Attendance as scheduled or excused – 100% Qualifications
- Strong written and verbal communication skills
- Ability to work within a fast pass environment
- Experience with Microsoft Office 365, particularly with experience in Excel
- Practice Management Software experience within a dental platform
- Bilingual in English and Spanish preferred
- Charismatic, Empathetic, Patient, and Kind
- Strong ability to work in a team environment
- Willing to learn and coachable
- Knowledge of dental terminology, insurance, platforms are a plus
- Credentialing Specialist works in a well-lighted, clean environment.
- The environment is at a moderate noise level office setting.
- Fundamental capabilities with photocopier machine, scanner machine, personal computer, and telephone.
- Face-to-face or other contacts with office Associates.
- Responsible for full cycle credentialing & re-credentialing process for all dental providers (dentists & dental assistants).
- Maintaining daily credentialing checklist with updates on all providers & plans.
- Organized with attention to detail.
- Prepare and maintain credentialing files and reports for all individual providers including maintenance of credentialing spreadsheet and provider rosters to comply with group delegation requirements.
- Process and file applications with third-party payors according to each payor’s individual requirements and addresses/corrects discrepancies as requested by payors.
- Conduct all follow-up steps till payor approval/completion is obtained.
- File provider practice change notifications and perform follow-up duties till confirmed complete by payors.
- Update NPI records according to provider specifications.
- Enroll provider in Medicare/Medicaid as prescribed by each program requirements.
- Track provider licensure and Board expirations and ensures timely processing
- Complete requests for re-credentialing for both providers and facilities.
- Accept and process all requests from payers for credentialing information/updates/new contracts and products.
- Answer questions, and process requests from staff/providers related to credentialing information.
- Prepare and maintain facility credentialing files and reports including maintenance of credentialing software, facility rosters and spreadsheets.
- Enrolls facilities in PPO and Medicaid programs.
- Address enrollment disconnects regarding facilities and providers
- Maintains quarterly payor specific rosters in accordance with CMS standards
- Assist in quarterly CAQH mass attestation
- Serves as liaison between OCPD and outside organizations and external customers.
- Participates in the Performance Improvement Program
- Performs other related duties as assigned.
- Communication Skills: The Credentialing Specialist collaborates with direct reports and billing and collection staff.
- Attention to Detail: Making sure every detail is right is crucial to the job.
- Leadership, Planning and Organizing Skills: Taking initiative, planning ahead and staying organized is essential.
- Analytical and Problem-Solving Skills and Judgment: Identify process and procedure
- problems and resolve them decisively, timely, rationally, effectively, and efficiently.
- Compassion: A desire to help others and care about all tasks.
- Interpersonal Skills: Relates to everyone in the Organization. Handles challenging situations with diplomacy and kindness.
- Teamwork: Across all dental practices and office staff.
- Fiscally Responsible: Find inefficiencies and cost-savings as part of the day-to-day job.
Hourly pay for 40 hours per week, benefits, PTO, and more.
Please send your updated resume in a word document.
Please make sure your experience in specific on your resume to include the main requirements. A ttg Talent Solutions Recruiter will contact you by email/phone/text. Please monitor your VM, inbox,or even junk for messages.