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Credentialing Manager

Company: Eastern Dental
Location: Edison
Posted on: August 7, 2022

Job Description:

Eastern Dental has been providing families with full-service dental care for over 30 years. From children to seniors, our skilled team of dentists and specialists provide the highest level of dental care to ensure healthy and happy smiles. If you are caring, compassionate and have a true desire to help others, becoming a member of the Eastern Dental Family may be the perfect opportunity for you.
SummaryThis role leads and manages the company-wide provider enrollment process for employed dental providers.
Essential Duties and Responsibilities


  • Manages a company-wide service for enrollment of employed dental providers with both governmental and commercial payers for purposes of claims submission
  • Provides direct leadership and management for provider enrollment team members
  • Responsible for daily/weekly/monthly reporting requirements to the business
  • Acts as primary liaison between insurance companies, internal team and field
  • Acts as transition manager between field operations, provider candidate and Human Resources
  • Responsible for re-credentialing timelines and tracking mechanisms
  • Responsible for managing malpractice and continuing education state obligation completion
  • Recruits, hires, and develops staff as needed to support an effective enrollment infrastructure
  • Creates effective training programs, policies, and processes to ensure best practice adoption
  • Creates and fosters a culture of customer service within the enrollment department to better serve all stakeholders
  • Develops actionable plans to scale enrollment services to maintain high customer service given changing workload demand
  • Participates in the administration of the credentialing/enrollment software system
  • Responsible for quality control of content and completeness of provider data within the credentialing/enrollment software system
  • Collects, monitors, and analyzes enrollment operations performance data relative to established goals and metrics to identify potential risks and/or areas of opportunity and prepares action plans for improvement
  • Focuses on enrollment related continuous process improvement to ensure optimal operation
  • Effectively collaborates with and serves as the primary point of contact for all company enrollment stakeholders including senior leaders, central billing office, operations, providers / administration staff
  • Establishes and maintains strong and mutually beneficial relationships with all participating health plans and serves as the primary point of contact for provider enrollment related topics with all applicable third-party payer representatives
  • Conducts regular communication with payers including quarterly distribution and reconciliation of provider rosters
  • Support and abide by the values of the company
    Education/Experience
    • Bachelor's Degree with a major in Healthcare Administration, Business Administration, or a closely related field.
    • Seven (7) years of progressive healthcare leadership experience including a minimum of (2) years of credentialing/provider enrollment experience in a dental, hospital, multi-provider ambulatory practice, or third-party payer setting.
    • Experience with enrollment / credentialing database software.
    • Prefer certification through NAMSS as Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional
      QualificationsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

      • Ability to demonstrate and utilize strong personal diplomacy skills, problem solving, and organizational skills.
      • Ability to understand and interpret detail information and present results in a manner in which others can clearly understand conclusions and recommendations.
      • Working knowledge of business best practices as they impact the operation and organization of physician practices.
      • Ability to communicate effectively before groups of customers or employees of the organization.
      • Relationships and experience with third party payers related to enrollment and contract issues impacting revenue cycle performance.
      • Understanding of provider enrollment in federal programs and delegated credentialing necessary to support these processes with both governmental and commercial payers.
      • Working knowledge of Microsoft Office Suite with intermediate proficiency in Excel, Word and PowerPoint
        Physical RequirementsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.by Jobble

Keywords: Eastern Dental, New York , Credentialing Manager, Executive , Edison, New York

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