The Credentialing Manager is responsible for overseeing all aspects of credentialing and re-credentialing of dental
providers. This position ensures all providers are appropriately credentialed, which includes maintaining current
information on file within the credentialing database.
• Completion of dental providers credentialing and re-credentialing applications
• Data entry of all new provider information into the credentialing database
• Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and
State/Federal regulations related to credentialing.
• Perform and collect primary source verification documentation for licensing, board certifications, proof of
professional liability insurance, National Practitioner Data Bank (NADB) and/or other sources as required based
on NCQA standards, dental plan requirements and company credentialing policies.
• Maintain the credentialing database and ensure up-to-date information is obtained at all times.
• Responsible for monitoring and managing credentialing/re-credentialing requirements and to ensure the collection
of all required renewal certifications are on file within the required time frame.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
• Attend monthly credentials committee meetings.
• Answer credentialing calls and emails to support providers, office staff, dental plan contacts and company
departments as necessary.
• Process provider demographic changes ensuring appropriate documentation has been submitted with the
changes, update credentialing database and notify dental plans of changes.
• Process provider network terminations, specialty/category changes, leave of absence requests.
• Cross train within department to support credentialing operations (providing back-up support for telephones,
credentialing files, vacation/PTO).
• Invest in the growth of team members, to help them achieve their personal/professional goals
• Participate in various educational/training as required.
• Perform other related duties as assigned by Director.
• Comply with HIPAA and Corporate Compliance program policies and other applicable corporate and
• Maintain privacy and confidentiality at all times.
The above statements are intended to describe the general nature and level of work being performed by people assigned
to this classification. They are not construed as an exhaustive list of all responsibilities, duties and skills required of
personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time
to time, as needed.
• Minimum of three (3) years of supervisory or management level experience in credentialing.
• Minimum of six (5) years credentialing experience.
• Experience with CAQH (Council for Affordable Quality Healthcare) database and application process.
• Working knowledge of credentialing accreditation regulations, policies and procedures, and NCQA standards also
• Must be able to operate a general computer, fax, copier, scanner and telephone.
• Must demonstrate exceptional communication skills, listening effectively and asking questions when clarification is
• Ability to plan, assign, supervise and evaluate the work of others, and to monitor goals, objectives, deadlines and
• Demonstrate accuracy, organizational and problem-solving skills. Look for ways to improve and promote quality
and monitors own work to ensure quality is met.
• Maintain confidentiality.
• Ability to assume responsibility and exercise good judgement in making decisions within the scope of authority of
• Must demonstrate and promote a positive team-oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must possess ability to manage change, delays, or unexpected events appropriately.
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