Sr Mgr Credentialing

Pacific Dental Services•Irving, TX

34d

About The Position

The Senior Manager, Credentialing serves as a key operational leader responsible for driving excellence across all credentialing and payer-related activities. This role acts as the primary liaison between PDS Health and external stakeholders, including insurance payors, third-party administrators, and strategic partners to ensure efficient, compliant, and high-quality credentialing operations.The Senior Manager supports the Director, Credentialing in executing organizational strategy, managing onshore and offshore teams, and ensuring clinicians are properly credentialed to participate in payer networks. This leader is accountable for team performance, service levels, compliance, and continuous process improvement, bridging the intersection of operations, compliance, and provider relations to support organizational growth.

Requirements

Experience: Minimum of 7+ years in credentialing within a healthcare or insurance organization (may substitute for a bachelor's degree).
Leadership: At least 3 years of management or supervisory experience in credentialing, provider enrollment, or related functions.
Operational Expertise: Deep understanding of payer enrollment, re-credentialing, and revalidation processes across multiple states and plans.
People Development: Proven ability to assess workflows, lead high-performing teams, and mentor, coach, and train staff for performance and growth.

Nice To Haves

Experience in a mid- to large-scale medical or dental support organization (MSO/DSO) or similar multi-site healthcare enterprise.
Direct experience with Medicare, Medicaid, and commercial payer enrollment processes.
Working knowledge of licensure, malpractice coverage, NPI, DEA, and provider credentialing documentation.
Familiarity with credentialing software systems (e.g., CredentialStream, Modio, CAQH) and payer/provider enrollment workflows.
Exposure to RPA or automation tools used to streamline credentialing operations.
Proven ability to manage scaled daily operations while executing 1-3-year strategic plans for efficiency and growth.
Strong organizational and time management skills with the ability to manage multiple priorities in a dynamic environment.
Experience with practice management systems or EHRs (e.g., Epic, Athena, Dentrix, or equivalent).
Exceptional team building, collaboration, and influencing skills with a focus on fostering a performance-driven culture.
Ability to interpret and apply complex policies, regulations, and procedures while maintaining confidentiality and discretion.
Strong judgment, analytical, and decision-making capabilities, including the ability to act decisively under pressure.
Excellent written and verbal communication skills, able to convey complex information clearly and diplomatically.

Responsibilities

Manages day-to-day operations of the credentialing team ensuring efficiency, quality, and compliance.
Mentors, develops, and evaluates team members to foster engagement, performance, and professional growth.
Tracks performance metrics, identifies trends, and partners with the Director to drive continuous improvement initiatives.
Anticipates mid- to long-term resource needs and contributes to workforce planning to support PDS Health's growth.
Builds and maintains strong relationships with payer representatives to proactively address credentialing, contracting, and claims issues.
Serves as an escalation point for complex payer or enrollment matters, ensuring timely resolution and effective communication.
Collaborates with the Director and other senior leaders in developing strategies to optimize payer mix, reimbursement rates, and provider participation.
Oversees payer contract administration, issue escalation, and vendor management for credentialing and enrollment operations.
In collaboration with the Director of Credentialing and Director, Business Process Outsourcing (BPO), determines optimal allocation of work between internal and offshore teams to maximize scalability and efficiency.
Ensures vendors meet or exceed defined service level expectations and performance metrics.
Partners with internal stakeholders and payors to streamline credentialing workflows and expand delegated credentialing opportunities.
Leverages technology platforms such as CredentialStream and automation tools (e.g., UiPath) to improve speed, accuracy, and compliance.
Establishes and monitors Key Performance Indicators (KPIs) and Service Level Agreements (SLAs), ensuring achievement and transparent reporting to the Director of Credentialing.
Coordinates provider onboarding and enrollment activities with Legal, Recruiting, People Services, IT, Learning & Development, and field operations.
Provides subject matter expertise and supports the development of training materials, manuals, and field-facing collateral to ensure operational consistency.
Collaborates with the Director and cross-functional leaders to align credentialing priorities with overall business objectives.
Ensures credentialing operations comply with federal, state, and payer-specific regulations, including NCQA and CMS standards.
Maintains documentation and audit trails required for internal and delegated payer audits.
Supports continuous quality improvement to maintain readiness for audits and compliance reviews.
Stays current on payer trends, regulatory changes, and credentialing technologies to anticipate business impacts.
Provides operational insights and recommendations to the Director for strategic planning and process optimization.
Performs other duties as assigned to support the Director of Credentialing and the evolving needs of the Revenue Operations organization.