Manager, Credentialing and Enrollment - Now Hiring

Overview:
Manager, Credentialing and Enrollment

Benevis LLC - Atlanta, GA

Work for a company that is truly making the world a happier place, one smile at a time! At Benevis, we create over a million smiles a year in the communities we serve and believe that every person deserves access to quality, affordable dental care. This mission drives everything we do. With over 3000 employees in offices across the country from clinical to support staff - we are united in our mission to create happy, healthy smiles through providing high quality dental care in a fun, compassionate environment. Are you ready to join us in creating our next million smiles? We have JUST the opportunity for you.

The Manager, Credentialing primarily provides daily management support in the form of directing and monitoring the work of department staff, providing technical guidance and training, and delivers staff performance evaluations in line with departmental KPIs. This position oversees new provider onboarding and internal credentialing and assists in the interactions between Revenue Cycle leadership, recruiting and field leadership to provide a transparent picture of the providers place in the overall process always ensuring that forward movement is taking place. The ideal candidate will possess strong people and process management skills as the role will be heavily project based to support and drive various business initiatives.
Responsibilities:

• Remain current on the licensure requirements for each of the states where dental professionals are being recruited and employed so that guidance and support given is accurate and up to date.
• Work with state licensing agencies as necessary to assist dental professionals in securing licensure as applicable.
• Document, organize and coordinate with onboarding recruiting associate and payor enrollment team, assuring receipt of all necessary requirements for a smooth E2E process.
• Perform continuous monitoring of network providers required by compliance and network payors.
• Produce reports and review application tracking to track progress of onboarding and payor enrollment.
• Review onboarding list daily to identify and address obstacles in onboarding and attend weekly onboarding calls.
• Provide Leadership with bi-weekly updates including any issues or concerns with team productivity or performance.
• Assist team in elevating issues to Director and the VP of Revenue Cycle, as necessary.
• Conduct workload discussions with team members at least twice per week to monitor production and performance.
• Provide guidance, support, and recommendations to upper management regarding department issues and resolutions.
• Handle other special projects as assigned.
• Provide technical guidance, training and mentoring to department staff.
• Perform research into specific issues as directed by Management for timely resolution.
• Remain current on industry trends.
• Prepares credentialing and re-credentialing Medicaid and Commercial applications of dentists and track all progression steps in internal database.
• Meets or exceeds individual productivity metrics, quality and timeliness standards as defined by department guidelines.
• Query National Practitioners Databank, State Licensing Board, Office of Inspector General, etc.
• Apply for Certificate of Insurance on behalf of the dentist.
• Ability to accurately build provider records and to enter relevant information into the credentialing database and other ancillary data repositories as needed.
• Ensure the provider's credentials comply with requirements of contracted payers and well as preparing providers files for the credentialing committee according to NCQA regulations.
• Maintains up-to-date physician database, including but not limited to medical licenses, drug enforcement administration certificates, professional liability insurance, provider numbers and renewal period expiration dates.
• Confirm all required verifications are complete and have been performed according to required standard and within required timeframes.
• Research detailed information on provider status in response to telephone or written inquiries.
• Researches and analyzes problems with enrollment packets and recommends resolutions.
• Runs queries, generates reports and credentialing document verification requests.
• The ideal candidate will demonstrate hands on, in-depth knowledge of provider onboarding, delegated credentialing, Medicaid payor requirements, and architecture regarding the necessary requirements to enroll doctors in dental plans. This role is ideal for the self-starter who can pivot to resolve issues creatively and tactfully. The individual will also demonstrate a high level of organizational skill and interact positively with all members of the Revenue Cycle team.
• The successful candidate will have prior occupational and supervisory experience with provider onboarding, credentialing (direct and delegated), and/or payor enrollment to be successful in the role.
• Previous leadership experience with demonstrated abilities to build and engaging teams is a definite plus.
• Clear, concise, and collaborative communication skills are essential to the role.

Qualifications: