Director of Credentialing & Payor Strategy - Remote Opportunity

Lumio Dental - Apply today, and we’ll light the way!

We're a dental partnership organization dedicated to preserving the integrity of private practice. We currently serve patients in Oklahoma, Arkansas, Kansas, Missouri, and Nebraska. Looking for a team who values you, your time, and your future? We're happy you found us!

Our Ideal Director of Credentialing and Payor Strategy

This candidate must be a subject matter expert in both credentialing and payor relations. A self starter with the ability to lead, and has experience creating processes and procedures to increase efficiency. A proven track record and established relationships with vendors, and understands the importance of working closely with cross functional teams and departments.

Bright Smiles, Brighter Futures

• Layout timeline and calendar on initial project and data gathering.
• Develop benchmarks and goals for each region.
• Design payor strategy by region, office, and provider.
• Coordinate utilization of leased networks and direct relationships.
• Coordinate and oversee the activities of the credentialing team
• Negotiate payor rates under each agreement.
• Work in conjunction with analytics to define and quantify the impact of each strategic change.
• Work closely with recruiting to track incoming providers, renewals and offboarding.
• Develop relationships with each Regional Manager to enhance support and implementation of plans designed above.
• Develop a shared electronic tool for tracking plan, status, and progress.
• Manages all re-credentialing as necessary for contracted payers.
• Serves as the primary point-of-contact for day-to-day provider enrollment and credentialing issues.
• Responds to and resolves unusual problems or delays in enrollment process (including claim denials).
• Creates enrollment policies and procedures as needed.
• Assists with department audits.
• Other appropriate duties as assigned.

Position Requirements

• Bachelor's Degree required, Master’s degree preferred
• Effective communication and leadership skills
• Strong system skills and proficient in Excel
• Positive attitude with a strong work ethic in a team setting
• Self-motivated employee who will seek assignments and offer help to others