Credentialing & Enrollment Manager

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.

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.

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.

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.