Description

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Location: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our leaders are expected to foster connection and teamwork by being present in the office 2 to 3 days per week. 

The opportunity:

Provider Enrollment and Credentialing Specialist reviews all aspects of the Initial/ Re-Apply Credentialing, Re-credentialing, privileging and overseeing the onboarding process for all incoming providers. Primary responsibilities include verifying all the credentialing criteria for practitioners that have applied to the network, including follow up with practitioners as needed to obtain information

How you will contribute:

• Verify potential and existing provider's licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification.

• Contract Validation: Review contract and application for completeness.

• Review National Practitioners Data Bank for adverse charges pending or filed against Provider.

• Review federal and/ or state OIG and SAM report for exclusion from the Medicaid or Medicare program.

• Review state Medicare OPT Out report for exclusion from the Medicare program.

• Monitors and reports provider complaints and utilization management reports.

• Assist with scheduling site reviews.

• Enroll the provider into payment system Windward.

• Enter all provider information into credentialing database Cactus.

• Maintain the integrity of the provider information in Windward and Cactus.

• Ensures credentialing file is in order with any issues flagged for committee.

• Meet required turnaround time and accuracy rate.

• Assist with other duties as assigned.

• Assist management in the implementation of department process improvements.

• Assist with the ongoing NCQA certification activities.

• Represent DentaQuest in a professional manner at all times while communicating with internal and external requestors.

• Maintains confidentiality of the credentialing information.

• Other duties as needed or required.

What you will bring with you:

• High School Diploma or equivalent.

• 1 year job related experience

• Previous experience working with files or the collection and coordination of data preferred.

• Knowledge of Dental terminology preferred.

• Good interpersonal skills.

• Ability to work independently.

• Excellent oral and written communication skills.

• Efficient PC skills (Word, Excel, Outlook, Work Flow Software, Time Tracking Systems).

• Ability to learn new software programs quickly.

• Ability to prioritize and organize multiple tasks.

• Ability to remain organized with multiple interruptions.

• Good customer service and problem resolution skills.

• Ability to navigate websites needed for credentialing purposes.

• Ability to adapt to a constantly changing environment.

• Ability to work in excess of 40 hours in a week.

• Required to attend additional training as requested/deemed necessary.

• Previous experience working with files or the collection and coordination of data preferred.

• Knowledge of Dental terminology preferred.

• Incumbent must be able to communicate effectively.  

• Manual dexterity and sitting is required in carrying out position duties.  

Salary:  $39,300 - 53,100

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. 

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive.  We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate.  We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.  Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.  Enjoy a flexible, inclusive and collaborative work environment that supports career growth.  We're proud to be recognized in our communities as a top employer.  Proudly Great Place to Work® Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.  Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.