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Full-time
bachelor degree, professional certificate
Medical insurance, Dental insurance, Vision insurance, Paid time off, Tuition reimbursement, 401k
Posted 1d ago
Apply by Jun 27
~40 hrs/week
Responsibilities
Lead the credentialing team in managing all elements of provider credentialing, re-credentialing, and delegated processes. Ensure compliance with NCQA, CMS, and federal/state laws while partnering with billing and operational teams to optimize onboarding.
Requirements
Requires a Bachelor's degree or professional certificate with 4-6 years of related experience, or 8+ years of experience in lieu of education. Proven experience in leading teams and assessing workflows within a healthcare or dental environment is preferred.
Full job description
Now is the time to join PDS Health. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today!
The Mgr, Credentialing leads a team responsible for all elements of the Credentialing, Recredentialing, and/or Delegated Credentialing processes. The Mgr, Credentialing will ensure ongoing execution of credentialing and other applicable provider onboarding functions completed are in accordance with applicable department policies and procedures.
Responsibilities
Lead Credentialing Team day to day activities while planning / executing for long-term growth
Mentor, develop, and train team members as well as educate the PDS team or field team members (affiliated clinical and operational) on the carrier and plan credentialing nuances
Ensure and maintain PDS compliance with all doctor’s credentials and licenses
Manage the credentialing process in accordance with NCQA, CMS, federal and state laws/standards
Develop and provide reporting and subject matter expertise to field and PDS team members including status reports, out-of-network reporting, re-credentialing updates, etc.
Develop and provide reporting to measure the throughput of the credentialing team, ensure timeliness and accuracy of all credentialing processes, and gap analysis for improvement
Partner with the billing department and Epic team to ensure all credentials are loaded timely
Establish and build relationships as the primary point of contact with insurance plan representatives
Analyze insurance plan trends that may impact the business (e.g., credentialing alternatives and competitors, the potential impact of the Affordable Care Act, etc.). make recommendations to optimize the credentialing process
Facilitate the credentialing team’s coordination and communication with the onboarding of new doctors and all departments, including Legal, People Services, DeNovo, and field leadership
Collaborate with billing and patient relations departments on denials, downgrades, or other anomalies to align billing practices with insurance carrier requirements that improve care and reduce overall cost
Oversee the development and maintenance of training programs, manuals, and all field/clinician-facing collateral
Lead/coordinate projects and special assignments as required by planning and identifying opportunities for process improvement/efficiency
Ensure alignment with the maintenance of audit procedures, including process adherence, document tracking, records, reports, policies, and procedures for accuracy and effectiveness
Other duties as assigned by management
Qualifications
Bachelor’s Degree or one-year certificate from an accredited college or technical school; or equivalent combination of education and experience, and 4-6 years of related business experience. In lieu of education, 8+ years of experience is required
Experience in assessing workflow, leading a team, mentoring, coaching, and training subordinate
Preferred
Experience in a multi-regional healthcare, retail, or dental company
Credentialing leadership with proven results
Knowledge/Skills/Abilities
Strong abilities in managing the daily operations of department(s) or work unit while developing short to medium term (1-3 years) goals
Fostering employee development by providing a supportive learning environment
Highly developed teambuilding, influencing, and collaboration skills
Ability to direct the work of others and work as a team leader in attainment of goals
Ability to interpret and apply policies and procedures
Ability to handle and maintain extreme confidentially with employee records, compensation information, etc.
Ability to draw valid conclusions; apply sound judgment in making decisions, and make decisions under pressure
Proficient communication skills with a commitment to achieving predetermined goals
Ability to read, analyze, and interpret documents such as professionals journals, technical procedure manuals, safety rules, operating and maintenance instructions, and governmental regulations
Ability to interpret a variety of instructions furnished in written, verbal or diagram form
Benefits
Medical, dental, and vision insurance
Paid time off
Tuition Reimbursement
401K
Paid time to volunteer in your local community
Compensation Information
$93,000.00-$117,000.00 / Annually
PDS Health is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.
Related keywords
CredentialingNCQACMSEpicHealthcareDentalRevenue OperationsProvider OnboardingComplianceAuditGap AnalysisAffordable Care ActRe-credentialingDelegated Credentialing
With 1,000+ practices in 24 states, PDS Health empowers clinicians through business support to enhance patient care.
Industry
Hospitals and Health Care
Company size
10,001+ employees
Founded
1994
Headquarters
Henderson, Nevada
LinkedIn followers
60,035
Founded in 1994, PDS Health is a leading healthcare support organization that partners with dental and medical providers across the U.S., providing comprehensive business services that enable clinicians to focus on high-quality patient care.
Our innovative approach includes an integrated health record system that combines dental and medical data, giving clinicians a complete view of patient health. This platform enhances care coordination, allows for early detection of health issues, and improves patient outcomes, ultimately reducing overall healthcare costs.
We strive to be the provider of choice in every market by equipping clinicians with access to advanced, proven technologies and offering ongoing professional development opportunities. Our commitment to education and training supports clinicians and team members in growing their careers, ensuring they have the skills and knowledge to excel in their fields.
PDS Health has been recognized multiple times on the Inc. 5000 list of America’s fastest-growing private companies and named one of the 50 most community-minded companies in the nation. With over 1,000 practices in 24 states, we are dedicated to creating healthier, happier patients and making a positive impact in the communities we serve.
Offices: 3521 Volunteer Blvd, Henderson, Nevada 89044, US · 17000 Red Hill Ave., Irvine, CA 92614, US
Based on 25 listings with disclosed salaries, most legal jobs in Irving, TX pay between $55k–$207k per year. Individual offers vary with seniority, company size, and specialization.
How many Legal jobs are open in Irving, TX right now?
There are currently 48 open legal positions in Irving, TX listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Legal roles in Irving, TX?
Companies currently hiring include MUFG, Abbott, Amerisure Insurance, Caterpillar Inc., McKesson Canada, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Legal jobs in Irving, TX?
Yes — 19 of the 48 open legal positions offer remote or hybrid work (5 remote, 14 hybrid).
How do I apply for Legal jobs in Irving, TX?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.