The Senior Credentialing and Insurance Specialist will be the in-house insurance expert on plan details, provider credentialing and provider licensure. This role will have a heavy focus on RCM functions such as claim submission, verifications, insurance payment posting, insurance AR, and patient AR. The Senior Credentialing and Insurance Specialist will impact results by delivering the Espire mission to team members and patients by living joyfully, leading bravely, and creating greatness.
Main Responsibilities:
• RCM functions including but not limited to, insurance plan strategy, claims management, insurance payment posting, insurance verifications, and claims and patient aging reports
• Support our group of practices in California, Colorado, Wyoming, Texas, Washington and Oklahoma in all functions RCM
Additional Responsibilities:
• Assist our credentialing division in managing all insurance payor relationships
• Assist our credentialing division in provide strategic analysis on insurance plan utilization
• Ensure all providers are appropriately credentialed
• Manage all provider malpractice enrollment
• Track all provider licensure
• Input all fee schedules
• Provide support on local market fee analysis
•
Education/License Requirements:
• High school diploma or GED, required
• Bachelor’s Degree in Business or related field, or equivalent experience, preferred
Experience Requirements:
• 5+ years’ experience in the dental insurance field, required
Skills Requirements:
• Expert level knowledge in dental insurance
• Proactive problem solving
• Analytical approach to providing recommendations
• Strong organizational skills
• Understanding of compliance and regulatory standards pertinent to scope of activities of job
• Ability to work in a team environment required
• Excellent coaching skills
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