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The primary purpose and function of the Delegated Credentialing is a process of verifying a dentist’s professional record. This includes verification of their career, education, training history, malpractice history, license verification and so on. Whenever a dentist applied for practice within a dental office, they are required to complete an application with important details that are asked for. The incumbent completes timely and accurate credentialing of providers with minimal guidance. Ensures that credentialing records comply with requirements of regulatory and accrediting agencies including the National Committee for Quality Assurance (NCQA), federal and state laws and delegated credentialing agreements.

Responsibilities

• Ensures all Dentists meet qualifications of NCQA Credentials Verification Organization (CVO) standards as well as other regulatory requirements and agreements.
• Performs primary source verification for applicants
• Credentialing Owner Doctors, Associates and Specialist on behalf of the insurance plans.
• Verify current credentials on file for Owner Doctors, associates and specialist on behalf of the insurance plans.
• Request NPI Type 1 (Provider NPI).
• Request Credentials (License, DEA, CPR, etc.)
• Complete Credentialing and Re- Credentialing applications and submit to dental Providers for signatures.
• Review signed contracts for accuracy.
• Identifying any Mal Practice issues with Dental Providers
• Prepare Dentist Packets for Delegated Credentialing Committee Review
• Submit the dental providers to desired insurance plans via excel spreadsheet within 48 hours of committee approval
• Update the doctors’ effective dates on Credentialing grid.
• Request and Follow up with Dentists/ Field for missing credentials.
• Maintain Insurance Provider Status Report and Provider Files with Current Credentials.
• Ensures appropriate documentation is maintained and that information is easily retrievable.
• Communicate issues and suggestions to improve processes.
• Ensure compliance with Company policies, as well as State, Federal and other regulatory bodies.
• The responsibilities listed are a general overview of the position and additional duties may be assigned.

Required

• Equivalent to high school diploma or general education degree (GED).
• 1-2 Years of related State Business Credentialing experience.

Benefits

• Medical, dental, and vision insurance
• Paid time off
• Tuition Reimbursement
• 401K
• Paid time to volunteer in your local community

PDS Health is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.