Virtual Assistant / Credentialing Specialist 

I handle incoming phone calls, emails, and inquiries from providers seeking information about dental insurance plans, including coverage details, policy limits, and eligibility criteria. I provide clear and accurate explanations of dental insurance benefits, including co-payments, deductibles, and exclusions. I assist dental offices in submitting claims for dental procedures, clarifying the claims process, required documentation, and timelines for processing and settlement. I also monitor the progress of claims, keep providersupdated on their status, and address any issues that may arise during processing. Addressing and resolving customer complaints related to coverage, claims handling, or service issues and working proactively to solve problems and improve customer satisfaction. I maintain accurate records of all customer interactions, transactions, comments, and complaints, ensuring compliance with federal and state regulations, including privacy laws like HIPAA.

I conduct detailed verifications of dentists' educational backgrounds, training, board certifications, work histories, and references. I ensure that all required documents, such as licenses, malpractice insurance certificates, and continuing education credits, are up to date and meet regulatory standards. Oversee the credentialing process, ensuring all dental providers are properly licensed, certified, and compliant with industry regulations. Conduct regular audits to ensure ongoing compliance with network standards and regulatory requirements. monitor deadlines for credential renewals to avoid lapses in provider eligibility and maintain accurate records of all credentialing information in a dedicated database or management system. Process credentialing application for Dominion National, Blue Cross Blue Shield and Blue Cross Dental and ensuring each providers are have the accurate fee schedule on their profiles. I am responsible for maintaining the accuracy and confidentiality of provider data, promptly updating any changes in provider status, contact details, or qualifications based on change request forms received from the office. I also ensure that all information is accurately encoded into the system.I stay informed about updates in credentialing standards, regulations, and best practices set by federal and state laws, as well as accreditation bodies like the Joint Commission. I provide support and guidance to dental providers about the credentialing process, including requirements and status updates. I also communicate effectively with providers, administrative staff, and external agencies to ensure the credentialing processes are smooth and efficient, Maintain regular communication with providers through newsletters, updates and outbound calls

Email support for 3 years receiving US dental providers contracts and applications, requesting credentialing applications, doing follow ups, sending correspondence via email such as welcome letter, termination letter, nom-compliant letters and receiving request to update informations (ex. TIN , Address, Name, etc. Changes)

Answering questions to Australian clients about their training appointments, payments , invoice and training certificates

Receiving calls from healthcare providers verifying benefits, eligibility and claims using ADA codes and Dental ADA codes. Responding promptly to customer inquiries.

*Updating provider contracts with our insurance. *Creating / processing tickets for facility updates (i.e Address , Tax id , Provider Id ,adding assoc dentist etc.) *Data Entry (Creating Provider profile and Facility profile with all of their information including the network participation and fee schedule info.) *Managing provider charts.