Company
healthcare
DirectorofCredentialing
Neural analysis suggests this role is
optimal for Senior candidates.
“Director of Credentialing. Skills: credentialing, vendor management, compliance, provider enrollment. Oversee the third-party credentialing vendor’s management of the full lifecycle of provider credentialing and recredentialing. Serve as the day-to-day point of contact for the third-party credentialing vendor”
What You'll Achieve.
ensuring the end-to-end credentialing and recredentialing processes for all dental providers are executed accurately and on schedule; ensuring that all practitioners maintain current, valid credentials; verifying compliance with applicable federal, state, and insurance payer requirements; ensuring accuracy and accountability; ensuring all provider records are accurate and up to date; facilitate timely provider enrollment, network participation, and contract setup; initiating renewals proactively; keeping the organization informed of updates that may impact operations; resolve credentialing discrepancies, denials, and compliance issues in a timely manner; ensure seamless provider onboarding and network integration
Industry & Context.
Analytical and problem-solving mindset with the ability to identify process improvements and implement solutions
Minimal travel may be required for conferences, payer meetings, or multi-site coordination
What They're Looking For.
Must Have
Bachelor's degree in healthcare administration, business administration, or a related field required, Minimum of 8 years of experience in healthcare credentialing, at least 3 years in a supervisory or management role, Direct experience with dental provider credentialing and payer enrollment required, Demonstrated experience working with CAQH, NPPES, PECOS, and major dental insurance carriers (Delta Dental, Cigna, MetLife, Aetna, etc. )
What You'll Do.
Oversee the third-party credentialing vendor’s management of the full lifecycle of provider credentialing and recredentialing
Serve as the day-to-day point of contact for the third-party credentialing vendor
and maintain credentialing policies
Maintain and manage the credentialing database
Coordinate between the third-party credentialing vendor
managed care organizations
and government programs
Monitor and track expiring licenses
malpractice insurance
and other required documentation
Prepare and present credentialing status reports
Serve as the subject matter expert on credentialing regulations
Investigate and resolve credentialing discrepancies
and compliance issues
Collaborate with human resources
and clinical operations teams
How You'll Work.
Team & Collaboration
Serve as the primary liaison between the organization and its third-party credentialing vendor; Coordinate between the third-party credentialing vendor, insurance companies, managed care organizations, and government programs; Collaborate with human resources, billing, and clinical operations teams
Communication Scope
Excellent verbal and written communication skills for engaging with providers, payers, and internal stakeholders
Process & Methodology
Excellent organizational and project management skills with the ability to manage multiple priorities and deadlines simultaneously
Full Job Description
Position Summary The Director of Credentialing serves as the primary liaison between the organization and its third-party credentialing vendor, ensuring the end-to-end credentialing and recredentialing processes for all dental providers are executed accurately and on schedule. This role is responsible for overseeing vendor performance, ensuring that all practitioners maintain current, valid credentials, and verifying compliance with applicable federal, state, and insurance payer requirements. The Credentialing Director develops internal policies and procedures, manages the flow of information between the organization and the credentialing vendor, and coordinates with insurance carriers and regulatory bodies as needed. Essential Duties and Responsibilities • Oversee the third-party credentialing vendor’s management of the full lifecycle of provider credentialing and recredentialing, including initial applications, renewals, and payer enrollment for all dental providers (dentists and specialists). • Serve as the day-to-day point of contact for the third-party credentialing vendor, monitoring performance against service-level agreements, ensuring accuracy and accountability, and escalating issues as needed. • Develop, implement, and maintain credentialing policies, procedures, and workflows in compliance with NCQA, CMS, state dental boards, and payer-specific requirements. • Maintain and manage the credentialing database (CAQH, provider enrollment portals, internal tracking systems), ensuring all provider records are accurate and up to date. • Coordinate between the third-party credentialing vendor, insurance companies, managed care organizations, and government programs to facilitate timely provider enrollment, network participation, and contract setup. • Monitor and track expiring licenses, DEA certificates, malpractice insurance, NPI numbers, and other required documentation, initiating renewals proactively. • Prepare and present credentialing status reports, compli
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