Credentialing Manager

COAST DENTAL•Tampa, FL

About The Position

The Credentialing Manager is responsible for daily supervision of the credentialing team to ensure all credentialing files are completed, submitted to, and approved by Coast Dental’s Credentials Committee prior to provider start dates. This position reports to the Director of Credentialing and works very closely with the Recruiting and Field Operations teams to meet the business needs of the organization, as well as maintain compliance with NCQA and other accrediting bodies for Coast Dental’s internal Credentialing Program.

Requirements

2 years of provider credentialing leadership or dental insurance experience required.
Advanced knowledge in MS Outlook, Word and Excel (including macro, vlookup, and ability to create formulas) is required.
Must be self-motivated; detail-oriented individual.
Strong management skills required.
Availability to attend all required training seminars and meetings at scheduled time.
Ability to multi-task and manage several projects at one time.
Ability to work in a fast-paced environment.
Ability to handle sensitive information and maintain confidentiality.
Ability to work independently and in a team environment.
Must maintain an excellent attendance and punctuality record.

Nice To Haves

Previous supervisory or management experience preferred.

Responsibilities

Provide daily management, oversight and leadership to the credentialing team, including payroll reconciliation
Monitor credentialing activities/process management issues and works to resolve
Close follow up on daily activities to ensure timely credentialing for the organization’s credentialing function
Ensure compliance with NCQA Standards in addition to State and Federal policies and regulations
Develop and submit timely reports on credentialing activities to Coast Dental’s delegated payers
Manages NEA and Eaglesoft data entry
Verify each initial credentialed and re-credentialed file is complete and complies with Coast Dental’s Credentialing Policies and Procedures
Coordinate Credential Committee meetings and Ad Hoc Committee meetings
Leads the response to all delegated client audits
Review and update Credentialing Policies and Procedures as directed, complies with NCQA and other State and Federal policies and regulations
Ensure credentialing application and documentation checklists are accurate
Cultivate and maintain strong interpersonal relationships with the credentialing team and delegated vendors
Observe industry standards, analyze, implement, and monitor credentialing initiatives to help reach company goals and objectives
Interview, train, and develop new staff, including responsibility for credentialing department software training.
Complete and or delegate all payer network accuracy requests for reconciliation within specified turnaround time.
Additional projects and/or responsibilities as assigned.