Credentialing Services Supervisor

Jobtailor; Deutschland; Vor Ort; EUR 60.000 - 90.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a Credentialing Operations Lead to manage a team responsible for provider onboarding and credentialing in a regulated dental insurance environment. You will ensure compliance with NCQA and Delta Dental standards and coordinate with internal and external stakeholders to maintain timely, accurate credentialing.

The role requires strong regulatory knowledge, supervisory experience, and excellent communication.

Qualifikationen

• Bachelor's degree or equivalent experience.
• Experience in credentialing and dental insurance preferred.
• Knowledge of state and federal insurance regulations, ERISA, and ASO agreements.
• Understanding of NCQA and Delta Dental standards is a plus.
• Strong analytical and problem-solving abilities.
• Excellent communication skills (verbal and written).
• Proficiency with MS Office applications.

Aufgaben

• Oversee day-to-day operations of a credentialing team.
• Coordinate initial and ongoing credentialing with NCQA and Delta Dental standards.
• Develop and execute credentialing and provider onboarding processes.
• Collaborate with provider services, providers and clients to ensure satisfaction and timeliness.
• Generate performance measures and monitor team performance.
• Coordinate with the Director of Compliance on department initiatives.
• Monitor KPIs to assess credentialing effectiveness and compliance.
• Drive continuous process improvement in enrollment and credentialing.

Kenntnisse

Leadership

Customer service

Analytical thinking

Verbal & written communication

Regulatory knowledge

Credentialing knowledge

Process & project management

Team coaching

Ausbildung

Bachelor's degree

Tools

Microsoft Word/Excel/Outlook/PowerPoint

Jobbeschreibung

Responsibilities

• Oversee day-to-day operations of a team consisting of all elements of the Credentialing process.
• Assist in ensuring the coordination of initial and ongoing compliance with National Committee for Quality Assurance (NCQA) and Delta Dental Plans Association standards.
• Ensure development and execution of Credentialing and other provider onboarding functions in accordance with applicable department policies and procedures.
• Work directly with provider services associates, providers and external clients to ensure satisfaction and timeliness.
• Generate performance measures and set goals while monitoring performance against them.
• Coordinate directly with the Director of Compliance to ensure alignment with all departmental and company initiatives.
• Monitor key performance indicators and metrics to assess provider enrollment and credentialing effectiveness, efficiency, and compliance.
• Be responsible for continuous process improvement in provider enrollment and credentialing processes.
• Maintain all providers’ contractual credentialing information for all Networks including Medicare Advantage and Medicaid.
• Run regularly scheduled reports to identify and address any outstanding applications, issues, and expiring information.
• Assist in development, implementation and maintenance of processes that support department and organization goals.

Requirements

• Bachelor’s degree from an accredited college or university or equivalent experience.
• Experience in the dental field preferred.
• Supervisory experience preferred.
• Working knowledge of state and federal insurance regulations, ERISA, and ASO agreements.
• Working knowledge of credentialing standards and processes.
• Understanding of dental insurance products and industry trends.
• Proven customer service and relationship building skills.
• Solid analytical and problem-solving skills.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.
• Process and project management experience required.
• Ability to coach and support a cohesive team.

Core Competencies

Demonstrates expertise in overseeing credentialing processes and ensuring compliance with NCQA and Delta Dental standards. Proficient in performance monitoring, process improvement, and team leadership within the dental insurance industry.