Manager- Credentialing & Provider Data Operations - Remote

USAble Life•Jacksonville, FL

16h•$81,000 - $117,000•Remote

About The Position

The Manager- Dental Credentialing and Provider Data Operations is responsible for the overall day-to-day management of the Credentialing and Provider Data Operations teams. This position will develop, manage, and monitor processes and procedures that support credentialing, re-credentialing, and data management processes in accordance with NCQA guidelines and business requirements. Oversees all of the credentialing functions including application management and CVO processes for primary source verification. Ensure compliance with the appropriate accrediting and regulatory agencies. Supervise credentialing and provider data team in the day-to-day management of the overall CVO credentialing process and provider database management.

Requirements

Advanced experience working with credentialing and provider data management
Excellent communication skills including the ability to address a wide range of audiences
Ability to work within 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 SalesForce and SpringCM
Ability to write reports, business correspondence and memos
Ability to define problems, collect data, establish facts, and draw valid conclusions
Skilled in developing policy and procedure documentation
Employee development and performance management skills
Bachelor's Degree, or related experience
3-5 years' experience leading credentialing programs, projects and, relationships
2 or more years supervisory experience
Strong knowledge of the health or ancillary insurance industry
Or, equivalent military experience

Nice To Haves

Master's Degree
1-2 years management/leadership experience preferred
Certification(s) may be desired

Responsibilities

Manage the credentialing process for all 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 current operating environment
Coordinate the management of the provider, practice 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 generation
Coordinate the management of credentials application to ensure distribution, receipt, processing and timely delivery
Coordinate the management of expirable process to ensure all provider licenses and certificates remain current 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 focus on delivery of a high-quality product with the greatest efficiency, in the least amount of time
Oversee and coordinate credentialing audits in compliance with downstream entities. Work directly with Dental Director and Credentialing Committee to ensure all files are reviewed, signed off on, and any follow-up action completed
Perform all activities associated with staffing including staff evaluations.
Provide guidance and feedback to staff to improve departmental service levels and efficiency
Performs other related duties and responsibilities as assigned