Manager - Credentialing

Role Description

This is a fully remote opportunity, giving you the flexibility to lead and support a credentialing team from anywhere. We’re looking for someone who can serve as a subject matter expert in commercial credentialing, so strong experience with commercial insurance is essential (dental experience is a plus). This role requires proven leadership experience, with 3–5 years in a credentialing management capacity, including developing teams and driving performance.

• Oversee the Credentialing department to ensure the providers are credentialed in a timely and accurate manner.
• Resolve complex issues and work with staff to provide feedback and training to ensure Credentialing processes are completed timely and accurately.
• Develop and implement departmental procedures, quality measures, set goals and objectives to ensure effective and compliant workflow.
• Foster an environment of continuous improvement through process and systematic efficiencies.
• Work in conjunction with Human Resources to evaluate viable candidates under consideration for hire.
• Develop and motivate staff; initiate and communicate a variety of personnel actions including employment, terminations, performance reviews, salary reviews, disciplinary actions, and development plans.
• Provide regular and behaviorally specific feedback to increase performance levels.
• Oversee staff timecard and PTO requests to ensure timely and accurate reporting.
• Develop and maintain standard procedures for the Credentialing department.
• Assist in resolving complaints and issues for clients, providers, and internal staff.
• Develop and maintain training documents to ensure accuracy and thoroughness.
• Work effectively and collaboratively with peers and other internal resources in diagnosing and resolving issues.
• Identify and report credentialing issues to appropriate departments and leadership.
• Assist in the ongoing evaluation of policies and procedures and assist in development and implementation of new efficiencies based on assessments.
• Work with Director of Provider Experience to identify, develop and implement best practices.
• Serve as subject matter expert for credentialing requirements, including NCQA standards, federal and state regulatory guidelines, and accreditation-related expectations.
• Provide leadership and guidance on credentialing policies, procedures, and operational practices.
• Monitor credentialing performance for large clients and drive corrective actions.
• Identify opportunities to improve consistency, reporting, and operational performance across large client credentialing processes.
• Act as an expert in area of credentialing and accreditation practices.
• Ensure all departmental processes meet organization and industry standards.
• Provide regular reporting and status updates to clients and participate in client meetings.
• Must comply with registering and creating your own id.me account or using your personal id.me account for identity verification.

Qualifications

• 2 year/Associate degree in Business or related field.
• 3 - 5 years of experience in credentialing management capacity.
• Ability to organize and report on large amounts of data.
• Ability to organize work appropriately to meet deadlines.
• Ability to successfully lead teams.
• Demonstrated ability to make appropriate decisions when faced with conflicting deadlines or needs.
• Demonstrated use of Microsoft Office products (Word, Excel, PowerPoint).

Requirements

• 2 year or 4 year degree in Business Administration or similar field (preferred).
• Experience with dental, commercial (preferred).
• Knowledge of Enterprise System (preferred).

Benefits

• Compensation Range: $85,284 - $127,926.
• Compensation Midpoint: $106,605.

Company Description

SKYGEN is the trusted partner for specialty benefits payers and government agencies responsible for the delivery and administration of dental and vision benefits. Through cutting-edge technology and service solutions, SKYGEN empowers clients to become the most efficient, effective healthcare organizations in the country.