Overview
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. 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 4545 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.
Principle 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 bull; Direct daily workflow across centralized credentialing team (5 FTE + outsourced
partners); balance capacity to meet SLA targets. bull; Own end-to-end process includes CAQH/PECOS management,
state licensure verification, background checks, malpractice coverage verification, and payer roster maintenance.
• Compliance & Risk Management bull; Ensure adherence to NCQA, CMS, state dental board, OIG, and payer-specific
standards; serve as point of contact for internal and external audits. bull; Maintain impeccable digital document
repository and audit trails; lead root-cause analysis and corrective action plans.
• Data, Reporting & Analytics bull; Maintain credentialing tracker and present insights to executive leadership. bull;
Utilize data to forecast resource needs and proactively flag emerging payer issues. bull; Present weekly KPI
scorecards to Sr. Director of Credentialing; proactively flag risks to targets with recommended corrective actions.
• People & Vendor Leadership bull; Recruit, develop, and retain high-performing credentialing specialists; create
individual development plans and succession pipeline. bull; Manage relationships and SLAs with third-party
verification companies and enrollment vendors.
1549 Ringling Blvd Suite 520 | Sarasota, FL 34236| dentalcarealliance.com
• Stakeholder Engagement bull; Partner with Revenue Cycle, Provider Recruitment, Operations, and Practice
Integration teams to align onboarding timelines and revenue goals. bull; Serve as liaison to payer contracting
leaders to expedite effective dates.
• Continuous Improvement & Innovation bull; Apply industry standard improvement processes. bull; 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
