Job Description

Role Description

The Credentialing and Enrollment will report to the Senior Manager of Credentialing and Enrollment to manage the credentialing process for all providers within the organization within their territory. This role is critical in ensuring that all providers are properly credentialed with insurance payors and maintain compliance with regulatory standards.

• Execution of Credentialing Process: Execute non-delegated credentialing process for new and existing providers, ensuring timely and accurate completion of all credentialing and re-credentialing applications.
• Insurance Payor Relationships: Serve as a point of contact for all insurance payor relationships in assigned area, resolving any issues related to provider credentialing.
• Compliance: Ensure that all credentialing activities comply with state, federal, and organizational regulations and standards.
• Documentation: Maintain accurate and up-to-date records of all credentialing activities, including applications, approvals, and renewals.
• Collaboration: Lead and mentor a team of credentialing specialists, providing guidance and support to ensure high performance and professional development.
• Problem Resolution: Address and resolve any issues or discrepancies that arise during the credentialing process.
• Reporting: Generate and analyze reports on credentialing activities, identifying trends and areas for improvement.

Qualifications

• Direct dental credentialing and enrollment experience 3 years or more
• Ability to travel up to 5%
• Ability to work remotely

Requirements

• Industry Knowledge: In-depth understanding of dental insurance industry practices, regulations, and trends, including a broad understanding of billing and cash collection nuances, to maximize insurance payments and benefits.
• Analytical Skills: Strong analytical and problem-solving abilities to interpret insurance data, identify trends, make informed decisions based on information provided by DCA’s credentialing SAAS reports.
• Execution Experience: Proven track record in collaborating with high-performing teams to achieve operational goals.

Expectations

• Collaboration: Work closely with cross-functional teams, including revenue cycle, operations, and clinical leadership, to align insurance plan management strategies with overall organizational goals.
• Continuous Improvement: Identify opportunities for process improvements, technology implementation, and innovation to enhance insurance plan management practices within the DSO.

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