Credentialing Manager

Company Description

Altius Dental is an innovative Dental Support Organization supporting over 30 dental practices across Texas and expanding. The team is dedicated to providing quality, compassionate, and accessible oral health care services to underserved and rural communities in Texas, aiming to deliver the highest level of quality outcomes to all patients.

Role Description

The Dental Credentialing Manager is responsible for overseeing and managing the credentialing and re-credentialing processes for dentists, hygienists, and other providers within the organization. This role ensures compliance with insurance payers, state regulations, and accreditation bodies while maintaining an efficient and organized credentialing system. The manager works closely with providers, payers, and internal departments to ensure timely credentialing and provider enrollments.

Key Responsibilities:

1.Credentialing & Re-Credentialing Process Management:

•Oversee the credentialing and re-credentialing of all dental providers with insurance networks, government programs (Medicaid, Medicare), and other third-party payers.

•Ensure providers meet all licensing, certification, and credentialing requirements.

•Maintain a detailed tracking system for all credentialing applications, renewals, and expirations.

2.Insurance Enrollment & Provider Maintenance:

•Submit and monitor provider applications for participation in PPOs, Medicaid, and other dental networks.

•Follow up with insurance companies and providers to ensure timely enrollment and approvals.

•Maintain up-to-date provider records with all payers and address any issues or discrepancies.

3.Compliance & Regulatory Adherence:

•Ensure compliance with all federal, state, and industry-specific regulations related to credentialing and provider enrollment.

•Keep up with changing credentialing requirements and adjust processes accordingly.

•Conduct regular audits to confirm all provider documentation is accurate and up to date.

4.Coordination & Communication:

•Serve as the primary point of contact between providers, insurance companies, and internal teams regarding credentialing matters.

•Work closely with HR, operations, billing, and revenue cycle teams to ensure smooth onboarding of new providers.

•Address credentialing-related issues promptly to prevent disruptions in patient care and reimbursement.

5.Database & Documentation Management:

•Maintain credentialing databases and provider profiles with accurate and current information.

•Organize and securely store all credentialing documents, licenses, malpractice insurance, and certifications.

•Utilize credentialing software and systems to streamline workflows and improve efficiency.

6.Process Improvement & Efficiency:

•Identify opportunities for improving the credentialing workflow to reduce processing time and minimize errors.

•Implement best practices to enhance efficiency and compliance.

•Train team members on credentialing procedures and updates as needed.

Qualifications & Requirements:

•Education:Bachelor's degree in healthcare administration, business, or a related field preferred.

•Equivalent experience in credentialing management may be considered.

•Experience: 3+ years of experience in dental or healthcare credentialing required.

•Strong understanding of dental insurance plans, provider enrollment, and Medicaid/Medicare credentialing.

•Experience managing a credentialing team is a plus.

•Skills & Competencies:

•In-depth knowledge of credentialing requirements and payer processes.

•Strong organizational skills with attention to detail and accuracy.

•Excellent communication and interpersonal skills.

•Ability to manage multiple tasks and meet deadlines.

•Proficiency in credentialing software, Excel, and other data management tools.

Work Environment & Schedule:

•Full-time position with US business hours (Monday–Friday).

•Hybrid or remote work flexibility may be available depending on company policies.

•Occasional travel for training or audits may be required.

Compensation & Benefits:

•Competitive salary based on experience.

•Paid time off and professional development opportunities.