Credentialing Services Supervisor

About the role

Delta Dental of Arizona, the state’s #1 dental and vision insurance company, is seeking a Credentialing Supervisor with a strong leadership mindset and exceptional analytical and problem-solving skills to join our Credentialing team. The Credentialing Supervisor’s role is to oversee day-to-day operations of a team consisting of all elements of the Credentialing process. Assist in ensuring the coordination of initial and ongoing compliance with National Committee for Quality Assurance (NCQA) and Delta Dental Plans Association standards including the National Provider File (NPF). Ensures that development and execution of Credentialing and other provider onboarding functions are in accordance with applicable department policies and procedures. Works directly with provider services associates, providers and external clients to ensure satisfaction and timeliness. Generates performance measures. Sets goals and monitors performance against goals.

Responsibilities

• Coordinates directly with the Director of Compliance to ensure alignment with all departmental and company initiatives, performance guarantees, and internal operational targets.
• Act as the company’s administrator between Symplr and DDMI to ensure the provider systems are working as expected.
• Monitors key performance indicators and metrics to assess provider enrollment & credentialing effectiveness, efficiency, and compliance.
• Responsible for continuous process improvement in provider enrollment and credentialing processes including standardized “Tool Kits”, training programs, and deployment of plans.
• Maintain all providers’ contractual credentialing information for all Networks including Medicare Advantage and Medicaid.
• Run regularly scheduled reports to identify and address any outstanding applications, issues, and expiring information.
• Assist in development, implementation and maintenance of processes that support department and organization goals.
• Monitors the team’s production, quality metrics, and workload distribution, including monthly and yearly review processes for each associate with focus on tangible SMART goals.
• Coordinates with HR to establish and conduct the hiring process and secondary downstream training/support for new associates.
• Provides cross departmental support for various activities related to necessary PR and claims support.
• Coordinates problem solving and quality improvement procedures by interacting with other departments to resolve current issues and avoid potential problems, ensuring customer satisfaction and