Credentialing Manager

Jefferson Dental and Orthodontics • Full-time • Dallas, Texas, United States • $70k - $80k / year • 3m ago

Who Are We?

We are Jefferson Dental & Orthodontics, and we believe in taking a personal approach to dentistry. Since our humble beginnings in Texas in 1967, we’ve been a trusted friend for our patients near and far. At Jefferson, we understand it takes more than clinical excellence to earn a patient’s trust. It’s of the utmost importance that we all see the patient as a unique individual and demonstrate that their care plan is designed around each of their needs. We’ll do whatever it takes to put a smile on each patient’s face, so the rest of the world can see how amazing it is. We truly change people’s lives. Do you want to be a part of our life changing team?!

Our philosophy is simple: Our Care Changes People’s Lives. We treat our patients like family to provide the best dental experience because we know a happy, confident smile leads to a better life. We deliver the highest quality care, making dentistry convenient and affordable for everyone.

Job Description:

Our organization is currently seeking a Credentialing Manager.

The Credentialing Manager is responsible for managing the credentialing and re-credentialing process for dental providers within our organization. This role will work closely with dental professionals, insurance companies, and regulatory agencies to maintain up-to-date enrollments and ensure compliance/licensure with industry standards. The Manager will also work closely with the Revenue Cycle Department as it relates to insurance claim trends and insurance fee schedule/contract negotiations. This role requires a hands-on leader willing to complete credentialing activities with his/her team(s), as needed to maintain timely completion of credentialing activities.

CredentialStream, CAQH experience as well as knowledge of TX Payor Networks is strongly preferred.

Major Duties and Responsibilities:

· Timely Credentialing and Re-credentialing

· Compliance and Regulations

· Provider Communication

· Documentation, licensure and Record Keeping

· Problem Resolution & Continuous Improvement

· Evolving policies and procedures

· Direct oversight of Credentialing team(s)

· Working manager - as needed

Additional responsibilities

· Collect and verify required documentation, including but not limited to licenses, certifications, malpractice insurance, and education history.

· Review and process credentialing applications for dental providers, ensuring accuracy and completeness.

· Submit applications to insurance companies, networks, and regulatory agencies as timely

· Track and manage credentialing timelines to ensure providers are re-credentialed before expiration. For new Providers, credentialed leading up to first day

· Stay updated on changes in healthcare laws, regulations, and payer policies.

· Communicate with dental providers to request additional information, clarify discrepancies, or assist with issues during the credentialing process.

· Provide updates and notify providers regarding credentialing status or required actions.

· Assist with the maintenance of provider directories and insurance network participation status.

· Maintain and safeguard accurate and organized records of credentialing and re-credentialing documents.

· Ensure all provider information is up to date and easily accessible.

· Prepare reports and assist with audits as required by internal and external stakeholders.

· Investigate and resolve issues related to provider credentialing or network participation.

· Act as a point of contact for resolving credentialing disputes or discrepancies with insurance carriers or regulatory bodies.

· Monitor and suggest improvements to the credentialing process to enhance efficiency and ensure adherence to best practices.

· Evolve existing policies and procedures for the Credentialing team

Skills and Abilities:

· Self-directed, organizes and prioritizes work, and manages multiple tasks and assignments

· Ability to work independently within guidelines and company policies

· Manages time well and performs assigned duties with attention detail, accuracy and follow-through with minimal supervision

· Skilled using Microsoft applications including Outlook, Teams, Word, Excel, PowerPoint and SharePoint

· Verbal and written communication skills with ability to provide written communication/education

· Excellent interpersonal skills and experience interacting in a fast-paced team environment

· Interacts with confidential information in a professional manner

· Minimum 3 years’ experience of Credentialing

Job Type: Full-time / Salary with bonus potential

Work Location: Remote / Hybrid option available out of corporate location in Dallas, TX 75234

Schedule:

· 8-hour shift

· Monday to Friday - CST time zone

Job Type: Full-time

Pay: $70,000.00 - $80,000.00 per year

Benefits:

401(k)
AD&D insurance
Dental insurance
Employee discount
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Vision insurance

Work Location: Hybrid remote in Dallas, TX 75234

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