Enrollment and Credentialing Manager

Overview

Position Summary :

The Enrollment and Credentialing Manager oversees the enrollments and credentialing of all dental providers in the affiliated network or Affordable Care practices.

This position reports directly to the Director of Insurance Services and coordinates and performs a variety of duties that are required for credentialing, re-credentialing and enrollment of both the clinicians and office locations.

The Enrollment and Credentialing Manager interacts with Insurance Payer Contacts, Senior Leaders, Revenue Cycle, IT, Clinical and Front Office Staff, Legal Recruiting, HR and other departments as necessary to facilitate the credentialing and enrollment processes to maximize reimbursement.

Responsibilities

Position Duties and Responsibilities :

• Manages and oversees the enrollment team, both Affordable Care internal employees and outsourced vendors employed by ACI to assist in the enrollment / credentialing process of our providers and locations.
• Provides metrics on enrollment and credentialing efforts.
• Accurately prepare, submit and follow up on all initial and all re-credentialing payer applications for providers and office locations.
• Contact and / or respond to requests for verification of credentials, current licenses etc. ensuring credentialing and licensing documents, as well as any provider notifications, are sent timely.
• Maintain the credentialing database with current information and effective dates.
• Review all payer directories for accuracy and work with insurance companies to resolve.
• Advises management team of any potential delays in a providers’ credentialing and works with revenue cycle team in resolving billing issues related to payer credentialing issues.
• Track status of applications, follow up as necessary and document activity in an accurate and timely manner.
• Maintain and update provider files and rosters including, but not limited to : internal provider and / or location roster lists, individual CAQH profiles, payer databases, NPI Database and Medicare database and any other as needed.
• Ensure all PHI (Protected Health Information) remains confidential and is kept in a secure location at all times.
• Collaborate with Insurance Service Department on communications and insurance training communications.
• Provide training and supervision to junior members of the Insurance Services Department.
• Provide reports and metrics to management when requested regarding clinicians and practices’ enrollment and credentialing with third party payers.
• Serves in an advisory role to the Insurance Services Director regarding new center openings, practice transitions, and acquisitions as related to commercial insurance and Medicaid plan enrollments, timing and legalities.
• Perform other duties as new opportunities arise and / or as assigned.

Qualifications

Qualifications

• Ability to interpret and effectively communicate insurance regulations.
• Excellent verbal and written communication skills.
• Ability to facilitate telephone, in-person, and / or web-based training sessions.
• Excellent problem-solving skills.
• Well organized, accurate, and thorough.
• Adaptable; readily adjusts work schedule to adhere to changes in the work environment and is able to manage competing demands.
• Adept at prioritizing, planning work activities, and developing reasonable action plans.
• Proficiency in all Microsoft Office products.

Education and Experience Requirements :

• Associate degree required; bachelor’s degree preferred.
• Minimum 7-10 years commercial insurance or Medicaid experience preferred.

Computer Skills :

• Proficiency in a Microsoft Windows environment.
• Proficiency with dental or medical software; Dentrix and Eaglesoft preferred.

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