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Credentialing & Enrollment Manager
<h2>Overview</h2> <p>Dental Care Alliance’s mission is to advance the practice of dentistry by partnering with and supporting dental professionals to create a lifetime of healthy smiles. Headquartered in Sarasota, Florida, DCA currently supports over 400 allied practices and supports over 900 dentists across over 20 States. DCA’s allied practices represent all dental specialties and treat patients under more than 150 brand names.Mission Alignment: Dental Care Alliance (DCA) advances the practice of dentistry by partnering with and supporting dental professionals to create a lifetime of healthy smiles. The Director, Credentialing & Payer Enrollment safeguards this mission by ensuring every DCA clinician is credentialed, enrolled, and revenue-ready as soon as the payors will allow.Role Summary: The Credentialing Manager provides enterprise-wide leadership for all delegated and non-delegated credentialing, re-credentialing, and payer enrollment activities, covering over 900 dentists across more than 400 allied practices in 20+ states. The role blends strategic vision, operational excellence, and regulatory acumen to optimize cash acceleration, mitigate compliance risk, and deliver superior provider and payer experience</p> <h2>Responsibilities</h2> <p>Achieve and sustain credentialing cycle time ≤45 calendar days through enhanced verification workflows.• Establish a 2-business-day internal application processing standard with real-time tracking.• Drive payer enrollment and delegated credentialing turnarounds to ≤30 days.• Attain 100% pass rate on all delegated payer audits through rigorous compliance controls.• Accelerate revenue recognition for new providers through faster application starts and payer roster onboarding.Principle Duties and Responsibilities (Essential Functions):• Strategic Leadership: In consultation with the Sr. Director, design multi-year roadmap for credentialing & enrollment that supports DCA growth, M&A integration, and new specialty offerings. • Operational Excellence • Direct daily workflow across centralized credentialing team (5 FTE + outsourced partners); balance capacity to meet SLA targets. • Own end-to-end process includes CAQH/PECOS management, state licensure verification, background checks, malpractice coverage verification, and payer roster maintenance. • Compliance & Risk Management • Ensure adherence to NCQA, CMS, state dental board, OIG, and payer-specific standards; serve as point of contact for internal and external audits. • Maintain impeccable digital document repository and audit trails; lead root-cause analysis and corrective action plans.• Data, Reporting & Analytics • Maintain credentialing tracker and present insights to executive leadership. •Utilize data to forecast resource needs and proactively flag emerging payer issues. • Present weekly KPI scorecards to Sr. Director of Credentialing; proactively flag risks to targets with recommended corrective actions.• People & Vendor Leadership • Recruit, develop, and retain high-performing credentialing specialists; create individual development plans and succession pipeline. • Manage relationships and SLAs with third-party verification companies and enrollment vendors.1549 Ringling Blvd Suite 520 | Sarasota, FL 34236| dentalcarealliance.com • Stakeholder Engagement • Partner with Revenue Cycle, Provider Recruitment, Operations, and Practice Integration teams to align onboarding timelines and revenue goals. • Serve as liaison to payer contracting leaders to expedite effective dates.• Continuous Improvement & Innovation • Apply industry standard improvement processes. • Pilot emerging technologies (e.g., AI-driven data scraping, electronic signatures) to further reduce cycle time.Core CompetenciesIndustry Knowledge: In-depth understanding of dental insurance industry practices, regulations, and trends, including a broad understanding of billing and cash collection nuances, to maximize insurance payments and benefits.Analytical Skills: Strong analytical and problem-solving abilities to interpret insurance data, identify trends, make informed decisions based on information provided by DCA’s credentialing SAAS reportsLeadership Experience: Proven record in leading and nurturing high-performing teams to achieve operational goals. ExpectationsCollaboration: Work closely with cross-functional teams, including revenue cycle, operations, and clinical leadership, to align insurance plan management strategies with overall organizational goals.Continuous Improvement: Identify opportunities for process improvements, technology implementation, and innovation to enhance insurance plan management practices within the DSO.</p> <h2>Qualifications</h2> <p>5+ years of experience in the dental/DSO environment. • 5+ years of leading teams of 5 or more people. • Ability to travel up to 10%• Ability to work remotely and direct remote teams</p>
