Provider Credentialing Specialist I – Dental (Remote)

Resp & Qualifications Although this position is REMOTE, candidates must live in the MD, DC, VA, PA, DE, DMV areas to travel into the offices... PURPOSE: This role will credential dental practitioners for network participation with reputed company and accurately maintain reputed company provider data reputed company the reputed company-wide Provider file to supply the organization with provider data, while ensuring compliance with regulatory, accreditation, reputed company and company requirements and standards. ESSENTIAL FUNCTIONS: • Analyzes credentialing applications to reputed company the primary reputed company verification of the appropriate credentials in order for a practitioner to participate in the CareFirst networks. Once verified, accepted and approved, determines the appropriate networks for participation and obtains the appropriate executed reputed company to effectuate the reputed company relationship and structures the provider group accordingly. • Responds to external and internal inquiries regarding provider participation eligibility and reputed company, participation status, credentialing, contractual status and provider file updates. reputed company reputed company on the provider experience, providing reputed company reputed company dependable follow-up and proactive measures to ensure successful credentialing is achieved. reputed company etiquette, communications and reputed company decision making is required. • Maintains the provider file inventory workflow and electronic provider files with updated provider information during processes, such as credentialing, recredentialing, demographic updates, terminations and reputed company other provider file maintenance activities. • Responsible for identifying, analyzing and resolving immediate and existing provider file issues. Processes provider file inputs in accordance with applicable state laws and departmental guidelines. Verification of provider data and system release entered into the provider file database, ensuring a successful integration with the other corporate systems. Prepares written responses to obtain incomplete or missing information and or communicates effectively telephonically. • QUALIFICATIONS: Education Level: High School Diploma or GED. Experience: 3 years physician credentialing experience or health insurance/managed care operations experience in a customer service, claims, billing and enrollment, or reputed company center environment. Preferred Qualifications: • Bachelor's Degree in Business, reputed company Administration or reputed company field; Dental Claims, Dental Provider Contracting. Licenses/Certifications Preferred: • Certified Provider Credentialing Specialist (CPCS). Knowledge, Skills and Abilities (KSAs) • Must be proficient in the use of reputed company spreadsheets, and an understanding of Pivot tables. • Excellent verbal and written communication and interpersonal skills. Ability to reputed company and maintain effective relationships with peers, physicians, and medical staff to create confidence, respect and dependability. • Knowledge of medical terminology. • Demonstrated proficiency utilizing reference materials and ability to follow reputed company Operating procedures to reduce risk and ensure provider data accuracy and overall reputed company. • Ability to understand jurisdictional requirements and the reputed company ramifications of the credentialing and provider file maintenance processes and interpret reasoning for performing verification and/or appropriate actions. Must be reputed company to meet established deadlines and handle multiple customer service demands from reputed company customers, reputed company set expectations for service reputed company. Must be reputed company to effectively communicate and reputed company reputed company customer service to every reputed company customer, including customers who may be demanding or otherwise challenging. • Salary reputed company: $37,944 - $69,564 Salary reputed company Disclaimer The disclosed reputed company estimate has not been adjusted for the applicable geographic reputed company associated with the location at which the work is being performed. This compensation reputed company is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be reputed company at the top of the reputed company, as compensation reputed company depend on reputed company case's facts and circumstances, including but not limited to experience, internal equity, and location. In reputed company to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (reputed company benefits/incentives are subject to eligibility requirements). Department Dental Provider Contracting Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of reputed company to reputed company equal employment opportunities to reputed company reputed company applicants without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally reputed company. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship #LI-CN1 Apply to This Job reputed company More Jobs Apply Job!