Dental Credentialing Manager

We are Rodeo!

Rodeo Dental & Orthodontics is one of the fastest growing, multi-specialty dental groups in the country.

The company’s team of 100+ award-winning doctors provide a full range of general dentistry, orthodontics, endodontics, oral surgery, and board-certified pediatric dental services Rodeo locations throughout the United States.

JOB OVERVIEW: The Dental Credentialing Manager manages the process of delegated credentialing workflow for dental providers from applications submission to approvals. Implements policies and procedures to ensure that applications are properly verified and accurately uploaded to our internal credentialing database system and submitted electronically to designated insurance payers.

REPORTS TO: Vice President of Revenue Cycle Management

SCHEDULE: This hybrid position requires a flexible schedule that may require extended hours as business requires – including evenings and weekends.

EXPECTATIONS: Oversee Credentialing Team and Vendor(s) workload

Oversee Delegated Credentialing Program

Ensure credentialing applications are submitted timely and accurately

Ensure doctors are properly re-credentialed

QUALIFICATIONS:

• At least 2 years of credentialing leadership experience
• At least 3 years direct experience in credentialing required, with two working years in a delegated environment
• Proficiency in CAQH, SkyGen and Primary Source Verification
• Working knowledge of Excel and Google sheets.
• Must be detail oriented and capable of multitasking various projects.
• Skill in exercising a high degree of initiative, judgment, discretion, and decision-making to achieve objectives.
• Skill in establishing and maintaining effective working relationships with payers, doctors, and operations team.
• Ability to maintain discretion with confidential information.
• Ability to create a work atmosphere which encourages motivation, innovation, collaboration and high performance.
• Ability to communicate clearly and effectively.

ESSENTIAL FUNCTIONS:

• Payer credentialing and revalidation - Completing and updating credentials for TX, CO and AZ Medicaid programs
• Re-credentialing - Commercial dental PPO networks.
• CAQH - Most payers require re-credentialing completed through CAQH. The manager would be responsible for overseeing the provider profile in CAQH and keeping the profile updated.
• Hospital credentialing and re-credentialing – Completing and updating credentials for medical staff at hospitals to grant hospital privileges to the doctors. All pertinent records must be shared with the Medical Staff such as licensures, TB, FLU Vaccines’.
• Maintain delegation committee records and meeting minutes.
• Primary source verification through credentialing software
• Quarterly delegation audits
• License management
• Credentialing software maintenance
• Performs all other duties as assigned

PHYSICAL REQUIREMENTS:

• Prolonged sitting and standing as needed
• Ability to lift up to 15 lbs

NOTE:

A review of this description has excluded the marginal functions of the position that are incidental to the performance of fundamental job duties. All duties and requirements are essential job functions.

This job description in no way states or implies that these are the only duties to be performed by the Associate occupying this position. Associates will be required to perform any other job-related duties assigned by their supervisor.