Senior Provider Onboarding Specialist

This position acts as a subject matter expert on provider contracting and credentialing tasks for all lines of business. This position is also responsible for analyzing escalations and providing root cause analysis to identify system/business process enhancements, and acts as a trainer and mentor to lower – level team members. They will evaluate key source documentation relevant to setting up and maintaining the integrity of provider contract and credentialing information within the Provider System of Record.

Responsibilities:

• Assists in the coordination and distribution of work; runs analytics on inventory to track if production expectations, performance guarantees, and customer service levels are being met.
• Acts as subject matter expert; Responsible for special handling accounts, escalations from team members, and participating in end-to-end process improvement, with emphasis on system enhancement and/or training gaps. This includes assistance with the development of Test Cases for system enhancements or process improvement initiatives.
• Assesses daily escalations and performs root cause analysis; coordinates cross-functional meetings with stakeholders to assess overall impact and solutions to be implemented as part of the resolution plans.
• Assists with project improvement strategies to ensure escalations associated with provider onboarding are mitigated and monitored.
• Performs monthly provider roster modifications and review of file discrepancies using Bump & Compare/Vlookup data solutions; performs provider contract and fee reconciliations in system of record as required through GSR reprocessing fee escalations and SWOT analysis reviews.
• Triages communications with providers to handle escalated inquiries or situations and follows through with partners to ensure full circle resolution and service levels are met.
• Provides guidance to internal and external customers on various items related to provider onboarding, including contracting requirements and SLA expectations for all lines of business. When errors occur, provides feedback and recommendations to management for resolution.
• Maintains the integrity of an electronic database and assists team members and dental provider's offices with entering provider contract details, business name changes, tax ID changes, termination of dental contracts, change of ownership, sale of practices, adding associates, license changes, dental specialty changes, updated contract information, management exceptions and research of claims processing issues.

• 3+ years of experience w/High School

• Bachelor's degree preferred. Experience working with high-profile or sensitive clients.

• Strong organizational/time management skills, with the ability to multi-task while maintaining excellent attention to detail
• Strong analytical, critical thinking and problem-solving skills
• Aptitude to learn and develop proficiencies with new concepts, legal requirements, processes and technology
• Effectively able to adapt to change and be comfortable handling risk and uncertainty
• Customer-focused with ability to empathize with customer
• Understands process flows and is able to identify roadblocks and devise solutions to improve processes
• Ability to maintain confidentiality when exposed to sensitive information
• Effectively able to teach less-senior employees department processes, policies and concepts
• Strong interpersonal, written, and verbal communication skills
• PC literacy; MSOffice skills (Outlook, Word, Excel, PowerPoint, MS Teams) with strong Word skills;

• Competitive base and incentive pay
• 401(k) with robust matching and non-matching contributions
• Rich medical & pharmacy benefits
• 100% employer-paid dental and vision benefits
• Holistic wellbeing program with deep financial incentives
• Generous paid time off plus 12 paid holidays and your birthday off
• Culture of growth and learning: career development; tuition reimbursement; recognition program
• Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
• Social responsibility and volunteer opportunities
• Employee discount program