(Archived) Payer Contracting Specialist

Company Overview:

Job Description:

Smile Brands, a three-time Glassdoor Best Place to Work, is seeking a Payer Contracting Specialist to join our team in Irvine! This position provides dental plan credentialing, enrollment and related support to the Operations Group by performing a board range of duties that includes completing contracting/credentialing paperwork, monitoring the contract process and reporting process, monitoring licensure, performing follow-up with plans and internal customers, completing W-9 forms, as well as completing various reports.

Essential Duties and Responsibilities

• Load provider, facility and plan information onto various databases quickly and without error
• Build a business relationship with the plan representatives
• Update, maintain and make available the status information on databases on a daily basis
• Review plan web-sites for provider and/or facility enrollment approvals
• Serve as the liaison and maintain open communication with dental office staff, internal departments and company representatives
• Maintain library of plan information and business rules
• Take ownership of plan reporting, ensuring timeliness, completeness, accuracy and serve as the liaison to dental plans on behalf of the dental offices, obtain provider and/or facility enrollment approvals, discuss issues and process improvement
• Review, research and report on adverse provider application responses
• Monitor licensure/credentials for expiration dates, ensuring there is no lapse in licensure, by communicating with Dr.’s, Office Managers, Field reps and Management; completing all necessary follow-up
• Maintain library of Dr.’s credentials
• Add new Dr.’s, (GPs and Specialty) to locations within markets
• Review applications, prepare verification, update and maintain all related databases
• Create any attachments/exhibits that may be required for applications or contracts
• Process contracts/ applications with all appropriate dental plans for new and existing offices, ensuring completeness, timeliness and accuracy
• Process new Doctors credentialing - obtain and review credentials and as necessary background checks
• Continually review the credentialing and contracting processes to ensure compliance; decide if a process should be stopped and brought to the attention of Supervisor and Director before proceeding
• Research billing/contacting questions received from plans, offices and/or billing offices
• Maintain “Provider Number” spreadsheet on common drive for company reference
• Process terminations
• Notify dental plans of terminations and locations changes, as well as PC, DBA and TIN changes, process all necessary paperwork, initial and recredentialing
• Meet with Doctors in person (whenever necessary) and be prepared to answer all questions they may have regarding contracting/credentialing process
• Process routine re-credentialing requests to include providing current documents and current attestation statements; complete monthly access survey requests
• Complete oversight audits as required
• Participate in ad hoc conference calls
• Complete all work accurately and in a timely manner
• Perform other related duties as directed by supervisor

Required Qualifications:

• Associate’s degree or Bachelor’s degree (preferred)
• 2 or more years of administrative experience in related field