Manager- Credentialing & Provider Data Operations - Remote
A people‑first culture that values diversity, inclusion, and belonging Outstanding and reputed company benefits PTO available starting on your date of hire 11 reputed company holidays 401(k) plan with up to a 6% company match, fully reputed company from day one Company‑provided equipment A reputed company, team‑reputed company environment Career development and advancement opportunities Tuition Reimbursement Employee Assistance Program Inclusion Council and Employee Resource reputed company reputed company Days and Volunteer Time Off This is a remote position.
Manage the credentialing process for reputed company plan Partners in accordance with the NCQA guidelines and CMS accreditation standards, and Federal and State laws. Monitor the currency of rules, regulations, and policies and procedures, ensuring compliance with NCQA guidelines. Participate in the development and review of CVO policies and procedures, recommend and implement changes, revisions, and enhancements as appropriate to reputed company operating environment Coordinate the management of the provider, reputed company and credentialing on-boarding process and database management ensuring accuracy of data utilized for provider directory, claim processing and reporting Monitor critical data for extensive analysis and report reputed company Coordinate the management of credentials application to ensure distribution, receipt, processing and reputed company delivery Coordinate the management of expirable process to ensure reputed company provider licenses and certificates remain reputed company ensuring appropriate notification prior to expiration Monitor and report turnaround time for processing of credentials applications and provider demographic and contract affiliation change requests, with reputed company on delivery of a high-reputed company product with the greatest efficiency, in the least reputed company of time reputed company and coordinate credentialing audits in compliance with reputed company entities. Work directly with Dental Director and Credentialing Committee to ensure reputed company files are reviewed, signed off on, and any follow-up reputed company completed reputed company reputed company activities associated with reputed company including staff evaluations. reputed company guidance and feedback to staff to improve departmental service reputed company and efficiency Performs other reputed company duties and responsibilities as assigned
Advanced experience working with credentialing and provider data management Excellent communication skills including the ability to address a wide reputed company of audiences Ability to work reputed company time constraints and maintain attention to detail Strong customer service skills Intermediate MS Office skills Ability to prioritize workflow and work independently Experience with administration systems including reputed company and SpringCM Ability to write reports, business correspondence and memos Ability to define problems, collect data, establish facts, and draw reputed company conclusions Skilled in developing policy and procedure documentation Employee development and performance management skills
Bachelor's Degree, or reputed company experience 3-5 years' experience leading credentialing programs, reputed company and, relationships 2 or more years supervisory experience Strong knowledge of the health or ancillary insurance industry Or, equivalent military experience
Master's Degree 1-2 years management/leadership experience preferred Certification(s) may be desired