Company: Eastern Dental
Posted on: August 7, 2022
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
- 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
- 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
- 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 /
- 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
- 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
- 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
- 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
Keywords: Eastern Dental, New York , Credentialing Manager, Executive , Edison, New York
Didn't find what you're looking for? Search again!