Credentialing Administrator

Full Time

As a Credentialing Administrator at Pacific Dental Services you will be coordinating credentials for Dentists with various dental insurance carriers. Being a part of the Contracts Department which is responsible for credentialing General Dentists and Specialists to ensure they possess the appropriate professional licenses and credentials to participate in the Dental Plans as required by the Insurance companies.  Responsibilities: Check Deal Log by-weekly for new offices opening dates.Obtain IRS Confirmation from Development Department.Confirm with VP of Operations who’s the Owner/Billing Provider.Verify copies of current credentials on file for Owner/Billing Provider.Request NPI Type 2 (Billing Entity NPI).Complete applications and contracts for Billing Provider and submit for signatures.Review signed contracts for accuracy.Submit the paperwork within 24 hours to the applicable plans for approval and acceptance into their networks. Update credentialing process on Pending Log.  Follow up with Dental Plans.  Process billing changes (ownership changes, pc changes, TIN changes).Credentialing, Owners, associates and specialist as required.Maintain Insurance Provider Status Report and Provider Files with Current Credentials. Check, open, and send inbound / outbound mail. Filing and Scanning.Communicate issues and suggestions to improve processes. Ensure compliance with Company policies, as well as State, Federal and other regulatory bodies.