Professional Relations Coordinator

Delta Dental of Wisconsin is seeking a

Professional Relations Coordinator

to assist our Professional Relations Team. This position is responsible for tasks including provider record maintenance, credentialing, preparing reports, selected review claim processing and supporting the Professional Relations teams, including workflow management and arranging logistics for department events.

This is an excellent opportunity to expand your skills and gain cross-functional experience. We offer a collaborative work environment, comprehensive benefits, and ongoing professional development opportunities.

Why Join Us?
Delta Dental of Wisconsin offers a competitive and comprehensive benefits package, including:

Medical and dental insurance

401(k) retirement plan with employer match

Generous Paid Time Off (PTO) program

Professional development and cross-training opportunities

Career growth and advancement potential

Key Responsibilities

Provide timely and accurate support through the Professional Relations phone queue and Professional Relations Coordinator inbox by addressing inquiries from dental offices related to provider agreements, fees, and claim reviews.

Develop and maintain provider records

Execute credentialing processes for all providers to ensure compliance with DDPA, NCQA, and CMS requirements, which includes accessing the National Provider Database

Perform functions as NPF Administrator and/or NPF Alternate

Assist with the completion of vital DDPA NPF tasks such as:

Error reports remediation

Annual Directory Accuracy Audit

Perform processes related to 1099 records

Administer review claims according to provider claim and code holds

Maintain claims identified on 900 and OT report; contact dental offices for follow-up as

Prepare filed fee updates for data entry

Create and maintain process and procedure documents.

Coordinate assigned support activities for meetings, conferences and department activities

Required Skills & Experience

Associate degree in a related business field and two years’ experience in a business setting or equivalent combination

Experience within the Insurance industry, or knowledge of dental business is preferred

Participate in ME verification processes to ensure secure and authenticated access to the National Provider Database

Demonstrated proficiency with MS Office Suite applications

Ability to effectively and efficiently prioritize and execute multiple tasks

Experience working in a fast-paced, team-oriented, collaborative environment

Strong interpersonal, written and oral communication skills

Ability to make decisions and use good judgment when working independently

Ability to operate a computer keyboard, mouse and other office equipment

What Makes You Successful
You are detail-oriented, take ownership of your work, communicate effectively, and continuously seek opportunities to improve processes and outcomes.

Education
Preferred
Associates or better in Business Administration or related field.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.

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