Provider Data Maintenance & Credentialing Specialist I - Remote In Jacksonville, Fl

When it comes to making a meaningful difference in the lives of our customers and employees, USAble Life is always ready. We are a diverse group of individuals working together to go the extra mile. Through our DEI initiatives, employees feel empowered to bring their talents and voice to our culture.

Our passion for delivering the best products is matched only by our passion for our people. We are committed to making a meaningful difference in the lives of others which extends beyond our office walls. USAble Life has a long tradition of supporting our communities, and we’re proud of the fact that our employees share that commitment.

We have been recognized as a “Best Places to Work” in Arkansas, Florida, and Hawaii. You’ll be rewarded with opportunities for personal and professional development and opportunities for advancement. This, coupled with our engaging culture and a comprehensive benefits package, ensures we are committed to our employees.

Check out how we make a meaningful difference in the lives of others!

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What We Offer You:

• A culture that values employees and celebrates, empowers, and inspires a diverse workforce
• Outstanding and affordable benefits package
• Yearly bonus potential and annual increases
• PTO provided at date of hire
• 11 paid holidays
• 401(k) with up to 6% match; fully vested from day 1
• Remote opportunities with company-provided equipment
• Team-oriented, collaborative group of peers
• Career advancement opportunities
• Tuition Reimbursement
• Employee Assistance Program
• Inclusion Council and Employee Resource Groups
• Recharge Days and Volunteer Time Off
• This is a remote position position in Jacksonville, FL

The base salary range for a Provider Data Maintenance & Credentialing Specialist I is $39,000 to $50,000. Actual salaries will vary by geographic location and are based on factors such as candidate’s qualifications, experience, skills, competencies, and company tenure and equity. In addition to base compensation, this role is eligible for an annual incentive plan based on company performance and individual performance.

Provider Data Maintenance & Credentialing Specialist I Overview

Conducts provider credentialing application and contract package review prior to processing. Performs timely data entry of provider application information and contract arrangements into administrative system. Prepares adverse files for review by the Dental Credentialing Committee. Updates and maintains contract and demographic information on participating providers. Generates correspondence to providers confirming contract or demographic changes, credentialing status, and requests for missing or incomplete information. Provides general assistance with projects as required.

Essential Duties

• Enters credentialing and re-credentialing applications into the administration systems.
• Conducts follow-up as necessary with Credentialing Verification Organization to obtain completed Primary Source Verification credentialing report in a timely manner.
• Communicates with providers regarding missing information from credentialing files and requests additional information from external agencies.
• Reviews credentialing reports loaded into the administration system for accuracy
• Performs timely data entry of contract arrangements into administration system following credentialing.
• Updates and maintains contract and demographic changes ensuring accurate reporting, claims payment and directory information.
• Ensures timely follow-up is conducted to secure missing information. Generates letters to providers following contract or demographic maintenance.
• Meets or exceed departmental and individual metrics goal expectations as required by productivity and quality.
• Prepares documents for contract execution
• Processes adverse files including researching information with appropriate agencies.
• Prepares adverse reports for review by the Dental Credentialing Committee.
• Performs telephonic and written correspondence outreach to providers for any missing, expired or incomplete documentation.
• Report to office once every 8 weeks
• May perform other duties as assigned

Required Knowledge, Skills, and Abilities

• Knowledge in the health or dental insurance industry
• Excellent communication skills including the ability to address a wide range of audiences
• Customer service skills
• Basic MS Office skills
• Ability to read documents and extract information
• Ability to understand and evaluate contractual language
• Ability to work within time constraints and maintain attention to detail
• Ability to prioritize workflow and work independently but coordinate efforts within a team

Required Education and Experience

• High school diploma or equivalent
• 2 - 4 years of related experience
• Or, equivalent military experience

Preferred Education and Experience

• Associate's Degree with 3 years of related experience

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