Credentialing Services Supervisor

This is a fully remote position, open to applicants in United States.

📋 Description

• Supervise the daily operations of the Credentialing team.

• Ensure initial and ongoing compliance with NCQA and Delta Dental Plans Association standards, which includes the National Provider File.

• Guarantee that Credentialing and provider onboarding processes adhere to departmental policies and procedures.

• Collaborate with provider services associates, providers, and external clients to ensure satisfaction and timely service delivery.

• Create performance metrics and track performance against established goals.

• Work alongside the Director of Compliance on departmental and organizational initiatives, performance guarantees, and operational objectives.

• Manage the Symplr and DDMI provider systems.

• Track KPIs and metrics related to provider enrollment and the effectiveness, efficiency, and compliance of credentialing.

• Champion continuous process improvements, develop standardized toolkits, training programs, and oversee plan implementation.

• Maintain contractual credentialing records for providers across all networks, including Medicare Advantage and Medicaid.

• Generate reports to identify and resolve outstanding applications, issues, and expiring information.

• Oversee team productivity, quality metrics, workload distribution, and SMART goals.

• Collaborate with HR on hiring and subsequent training/support for new associates.

• Provide cross-departmental assistance for public relations and claims activities.

• Address issues and enhance business processes in conjunction with other departments.

• Gather statistical data and share results with management.

• Tackle provider credentialing issues and escalate concerns to the credentialing committee.

• Manage NPF and other credentialing audits.

• Serve as backup support for fellow credentialing team members.

• Execute miscellaneous duties as assigned.

⛳️ Requirements

• Bachelor's degree from an accredited institution or equivalent experience.

• Preferred experience in the dental field.

• Supervisory experience is preferred.

• Knowledge of state and federal insurance regulations, ERISA, and ASO agreements is essential.

• Familiarity with credentialing standards and processes is required.

• Understanding of dental insurance products and industry trends is important.

• Demonstrated customer service and relationship-building capabilities.

• Strong analytical and problem-solving skills.

• Excellent verbal and written communication abilities.

• Proficient in Microsoft Word, Excel, Outlook, and PowerPoint.

• Required experience in process and project management.

• Ability to coach and foster a cohesive team environment.

• Must verify identity and eligibility to work in the United States.

• Required to complete the employment eligibility verification form upon hire.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• 401(k) plan.

• Student loan assistance.

• Six weeks of paid parental leave.

• Volunteer PTO.

• A collaborative, service-oriented, integrity-focused, and inclusive workplace culture.