Compliance and Credentialing Manager
1 week ago
Simply Dental Management is seeking an experienced Compliance and Credentialing Manager to enhance our compliance and credentialing processes. This hybrid position is based out of our Resource Center in Hopkinton, MA.
Responsibilities- Advise executives within the company and work alongside employees and departments to develop a company-wide culture of compliance.
- Manage all day-to-day aspects of the company's compliance program.
- Coordinate compliance policy development and/or revision, as necessary.
- Create and ensure full implementation of the compliance program at all new/existing sites.
- Respond to alleged violations of rules, regulations, policies, procedures, and standards of behavior by evaluating or recommending the initiation of investigative procedures.
- Develop or revise training and education programs for regulatory changes and topics identified as potential risk areas.
- Stay current on State and Federal statutory and regulatory changes on an ongoing basis and provide regulatory expertise and interpretation to management and staff.
- Assess auditing and monitoring trends and coordinate mitigation activities when opportunities for improvement (audit variances) are identified.
- Conduct focused compliance audits on topics of concern.
- Coordinate internal investigations and any resulting corrective action (e.g. making necessary improvements to dental service policies and practices, taking appropriate disciplinary action, etc.) with all departments and any other agents as appropriate.
- Maintain all related reports and analyses.
- Travel into the field as needed (approximately 30-40% of the time).
- Oversee, manage, and audit new provider files including, but not limited to, up-to-date information needed to complete required governmental and commercial payer credentialing applications.
- Oversee and audit provider CAQH databases, including internal provider grid, to ensure all providers are up to date and in good standing.
- Manage third-party compliance relationships.
- Manage and audit internal provider grid to ensure all information is accurate and logins are available.
- Work proactively with the Revenue Cycle Director and billing team to identify and resolve any denials or authorization issues related to provider credentialing.
- Ensure accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
- Adhere to a high level of professional and ethical standards (in accordance with HIPAA standards).
- Other duties as assigned.
- Bachelor's degree preferred.
- Clinical experience highly preferred.
- Minimum of 3-5 years relevant experience.
- Additional compliance certifications considered a plus.
- Experience in the dental industry is required.
- Excellent computer skills including Microsoft Office and Dental Software.
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