Credentialing Manager (Multi-unit healthcare environment required)

A growing, Denver based healthcare company is adding a Credentialing Manager to their team

This Jobot Job is hosted by: Lauren Spann
Are you a fit? Easy Apply now by clicking the "Quick Apply" button and sending us your resume.
Salary: $85,000 - $100,000 per year

A bit about us:

A growing, national, multi-unit healthcare organization with headquarters in Denver

Why join us?

• Great work/life balance- flexible and hybrid work schedule (following training)
• Competitive compensation and benefits plan
• Excellent team environment- collaborative, supportive, kind and great leadership support

Job Details

Jobot is partnering with a growing healthcare organization to staff a position as a Credentialing Manager. The Credentialing Manager is responsible for leading all credentialing, recredentialing, provider enrollment, delegated credentialing, and payer participation activities across a multi-location dental organization.

• Lead, coach, and develop a team of credentialing and provider enrollment specialists.
• Oversee initial credentialing, recredentialing, provider enrollment, revalidation, and demographic maintenance for dental providers and locations.
• Serve as the organization's subject-matter expert for dental Medicaid credentialing and enrollment.
• Manage provider and group enrollment across multiple state Medicaid programs and Medicaid managed care organizations.
• Oversee revalidations, ownership and control disclosures, fingerprinting or screening requirements, site visits, affiliation requests, and changes of information.
• Lead and administer delegated credentialing programs with contracted payers.
• Ensure credentialing and recredentialing activities comply with delegation agreements, payer policies, applicable regulatory standards, and internal policies.
• Maintain complete and compliant credentialing files, committee documentation, policies, procedures, reports, and quality-control records.
• Serve as an escalation point for payer enrollment, participation, and contracting issues.
• Negotiate or support negotiations related to network participation, provider effective dates, closed panels, retroactive enrollment, reimbursement arrangements, and contract exceptions.
• Lead credentialing activities associated with new office openings, acquisitions, mergers, provider transitions, and market expansion.
• Develop dashboards and reports for application status, aging, provider readiness, recredentialing, expirables, audit compliance, and staff productivity.
• Monitor key performance indicators and identify bottlenecks, recurring payer issues, and opportunities for automation.
• Perform routine quality audits of credentialing files and enrollment records.

We are looking for someone who brings:

• Bachelor's degree in healthcare administration, business, or a related field, or equivalent relevant experience.
• At least five years of progressive credentialing, provider enrollment, payer relations, or network management experience.
• At least three years of leadership or direct staff-management experience.
• Significant credentialing experience within a dental service organization, multi-location dental group, or comparable multi-unit healthcare environment.
• Extensive experience with dental Medicaid enrollment, revalidation, managed Medicaid plans, and state-specific provider enrollment requirements.
• Demonstrated experience managing delegated credentialing programs and payer audits.
• Experience negotiating with payers, provider relations representatives, government agencies, and/or healthcare providers.
• Strong knowledge of CAQH, NPPES, Medicaid enrollment portals, payer portals, primary-source verification, sanctions monitoring, and provider data management.

Interested in hearing more? Easy Apply now by clicking the "Quick Apply" button.

<sub>Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Jobot also prohibits harassment of applicants or employees based on any of these protected categories. It is Jobot’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions.

Sometimes Jobot is required to perform background checks with your authorization. Jobot will consider qualified candidates with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance.

Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal.

By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Jobot, and/or its agents and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here: jobot.com/privacy-policy</sub>