Job Description

Job Location: FL Corporate Support - Tampa, FL 33634
Position Type: Practice SupportJob Purpose:
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.
Duties and 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.
Knowledge, Skills and Abilities:
- 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.

Qualifications
- Associate’s degree and/or equivalent experience.
- Previous supervisory or management experience preferred.