Provider Enrollment & Credentialing Specialist, Dentaquest

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.
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.
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Location: We welcome applicants from anywhere in the U.S.
At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.
The opportunity: Provider Enrollment and Credentialing Specialist understands and executes all aspects of the Initial/ Re-Apply Credentialing, Re-credentialing, privileging and the onboarding process for all incoming providers.
How you will contribute:

• Review National Practitioners Data Bank for adverse charges pending or filed against Provider.
• Monitors and reports provider complaints and utilization management reports
• Review federal and/ or state OIG and SAM report for exclusion from the Medicaid or Medicare program.
• Assist management in the implementation of department process improvements.
• Ability to independently, accurately, and timely resolve credentialing issues presented by an external or internal customers.
• Maintain the integrity of the provider information in Cactus
• Enter all provider information into credentialing database Cactus.
• Other duties as needed or required.
• Assist with the ongoing NCQA certification activities.
• Ensures credentialing file is in order with any issues flagged for committee.
• Represent DentaQuest in a professional manner at all times while communicating with internal and external requestors. Maintains confidentiality of the credentialing information.
• Meet required turnaround time and accuracy rate. Coordinate and complete special projects as needed.
• Verify potential and existing providers licensure, NPI, insurance, CDS, DEA certificate, education, hospital privileges, board certification.
• Review state Medicare OPT Out report for exclusion from the Medicare program.
• Collaborate with the team to identify opportunities for improvement both within the department and interdepartmental. Assist in resolving escalated provider set up issues.

What you will bring with you:

• 2 years related experience.
• Associate degree or equivalent experience required.

Preferred Skills

• Strong interpersonal skills.
• Ability to remain organized with multiple interruptions.
• Excellent oral and written communication skills.
• Ability to prioritize and organize multiple tasks.
• Proficient using department software (Credentialing and Enrollment Systems, Word, Excel, Outlook, Work Flow Software, Time Tracking Systems).
• Excellent customer service and problem resolution skills.
• Ability to work independently.

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.
Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!
Life is brighter when you work at Sun Life

• A flexible work environment with a friendly, caring, collaborative and inclusive culture
• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
• Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running
• Great Place to Work® Certified in Canada and the U.S.
• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account

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.
If you are a California resident, the salary range for this position is:

• Southern region: $39,300-$53,000 annually.
• Central region: $41,400-$59,900 annually
• Northern region: $44,300-$59,800 annually.

If you are a Colorado resident, the salary range for this position is $37,500-$50,600 annually.
If you are a New York resident, the salary range for this position is $44,300-$59,800 annually.
If you are Washington resident, the salary range for this position is $41,400-$59,900 annually.
We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.
Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation 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 [email protected] to request an accommodation.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
Job Category:
Customer Service / Operations
Posting End Date:
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