Manager- Credentialing & Provider Data Operations - Remote

When it comes to making a meaningful difference in the lives of our customers and employees, USAble Life is always ready. We are a diverse group of individuals working together to go the extra mile. Through our DEI initiatives, employees feel empowered to bring their talents and voice to our culture.

Our passion for delivering the best products is matched only by our passion for our people. We are committed to making a meaningful difference in the lives of others which extends beyond our office walls. USAble Life has a long tradition of supporting our communities, and we're proud of the fact that our employees share that commitment.

We have been recognized as a "Best Places to Work" in Arkansas, Florida, and Hawaii. You'll be rewarded with opportunities for personal and professional development and opportunities for advancement. This, coupled with our engaging culture and a comprehensive benefits package, ensures we are committed to our employees.

Check out how we make a meaningful difference in the lives of others!

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What We Offer You

At USAble Life, we believe in supporting our employees both personally and professionally. Our benefits and culture are designed to help you thrive.

• A peoplefirst culture that values diversity, inclusion, and belonging
• Outstanding and affordable benefits
• PTO available starting on your date of hire
• 11 paid holidays
• 401(k) plan with up to a 6% company match, fully vested from day one
• Companyprovided equipment
• A collaborative, teamfocused environment
• Career development and advancement opportunities
• Tuition Reimbursement
• Employee Assistance Program
• Inclusion Council and Employee Resource Groups
• Recharge Days and Volunteer Time Off
• This is a remote position.

Life Takes You Places! Are you ready to join us?

The starting base salary range for a Manager-Dental Credentialing and Provider Data Operations is $81,000 to $117,000. Final compensation is determined by geographic location and a variety of factors, including qualifications, experience, skills, competencies, and internal equity. In addition to base compensation, the position is eligible for an annual incentive plan based on company and individual performance.

Manager-Credentialing and Provider Data Operations Overview

The Manager- Dental Credentialing and Provider Data Operations is responsible for the overall day-to-day management of the Credentialing and Provider Data Operations teams. This position will develop, manage, and monitor processes and procedures that support credentialing, re-credentialing, and data management processes in accordance with NCQA guidelines and business requirements. Oversees all of the credentialing functions including application management and CVO processes for primary source verification. Ensure compliance with the appropriate accrediting and regulatory agencies. Supervise credentialing and provider data team in the day-to-day management of the overall CVO credentialing process and provider database management.

Essential Duties:

• Manage the credentialing process for all plan Partners in accordance with the NCQA guidelines and CMS accreditation standards, and Federal and State laws.
• Monitor the currency of rules, regulations, and policies and procedures, ensuring compliance with NCQA guidelines.
• Participate in the development and review of CVO policies and procedures, recommend and implement changes, revisions, and enhancements as appropriate to current operating environment
• Coordinate the management of the provider, practice and credentialing on-boarding process and database management ensuring accuracy of data utilized for provider directory, claim processing and reporting
• Monitor critical data for extensive analysis and report generation
• Coordinate the management of credentials application to ensure distribution, receipt, processing and timely delivery
• Coordinate the management of expirable process to ensure all provider licenses and certificates remain current ensuring appropriate notification prior to expiration
• Monitor and report turnaround time for processing of credentials applications and provider demographic and contract affiliation change requests, with focus on delivery of a high-quality product with the greatest efficiency, in the least amount of time
• Oversee and coordinate credentialing audits in compliance with downstream entities. Work directly with Dental Director and Credentialing Committee to ensure all files are reviewed, signed off on, and any follow-up action completed
• Perform all activities associated with staffing including staff evaluations.
• Provide guidance and feedback to staff to improve departmental service levels and efficiency
• Performs other related duties and responsibilities as assigned

Required Knowledge, Skills, and Abilities:

• Advanced experience working with credentialing and provider data management
• Excellent communication skills including the ability to address a wide range of audiences
• Ability to work within time constraints and maintain attention to detail
• Strong customer service skills
• Intermediate MS Office skills
• Ability to prioritize workflow and work independently
• Experience with administration systems including SalesForce and SpringCM
• Ability to write reports, business correspondence and memos
• Ability to define problems, collect data, establish facts, and draw valid conclusions
• Skilled in developing policy and procedure documentation
• Employee development and performance management skills

Required Education and Experience:

• Bachelor's Degree, or related experience
• 3-5 years' experience leading credentialing programs, projects and, relationships
• 2 or more years supervisory experience
• Strong knowledge of the health or ancillary insurance industry
• Or, equivalent military experience

Preferred Education and Experience:

• Master's Degree
• 1-2 years management/leadership experience preferred
• Certification(s) may be desired

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