[Hiring] Credentialing & Enrollment Manager @Dental Care Alliance

Role Description

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.

Responsibilities

• 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.

Principal 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.
• 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 Competencies

• Industry 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 reports.
• Leadership Experience: Proven record in leading and nurturing high-performing teams to achieve operational goals.

Expectations

• Collaboration: 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.

Qualifications

• 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.