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Job Summary

The role of the Network Compliance & QA Program Manager is to ensure the operational teams institute and follow the compliance program’s regulatory and contractual standards for commercial, DHMO and Medicare dental lines of business. This position is also responsible for day-to-day oversight of the HCSC and DenteMax dental credentialing process, management of our credentialing vendor and oversight of the DenteMax & HCSC provider grievance process. Oversee the daily operations for credentialing, manages the credentialing application process, develops efficient workflows, maintains credentialing tracking files, and analyzes state regulatory licensure requirements and regulatory changes. Responsible for managing compliance and QA analysts who engage with peers to conduct audits and QA programs; also responsible for leading the training role who supports the Networks Division.

This role requires the ability to handle sensitive matters with the utmost discretion. The role is responsible for creation and management of the internal and external provider and client audits. Oversight of quality performance audits and maintaining quality assurance statistics for Network operational staff. Responsible for development of training programs to onboard and create continuing education or learning opportunities. Will lead and coach teams providing day to day responsibilities outlined therein.

Required Job Qualifications:
* Bachelor’s Degree and 5 years of experience directly related to the duties and responsibilities specified; OR 9 years of experience directly related to the duties and responsibilities specified.
* 1+ years of supervisory/ leadership experience managing multifunctional teams.
* Demonstrated experience auditing and maintaining detailed complex provider records.
* In depth understanding of federal and state regulations impacting provider credentialing.
* Experience balancing multiple priorities while meeting commitments for quality and delivery at agreed upon schedules.
* Excellent multi-tasker with ability to remain calm in fast paced environments.
* Ability to work autonomously and efficiently within designated timeframes or deadlines.
* Communicates effectively orally and in writing.
* Proficient with Word and Excel.
* Strong Interpersonal, Leadership, Organizational and Analytical skills.
* Dental industry knowledge.

Preferred Job Qualifications:
* 5+ years of experience in dental provider credentialing
* Established experience coordinating client audits
* Strong knowledge of quality review processes

THIS IS A FLEX ROLE WORKING 3 DAYS IN OFFICE AND 2 DAYS FROM HOME

#LI-HYBRID-FLEX

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HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$88,700.00 - $160,200.00

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Mgr Network Compliance & QA