PDS Health · 1 week ago
Mgr, Credentialing
Irving, TX
Full-time
Onsite
Mid, Senior Level
$84K/yr - $106K/yr
5+ years expPDS Health is a company that offers opportunities to learn new skills from experienced professionals. The Manager of Credentialing is responsible for leading the credentialing functions for all business units, ensuring compliance and efficiency while collaborating with other departments and vendor partners.
DentalFitnessHealth CareWellness
Responsibilities
Lead the Credentialing Team day-to-day operations and activities
Mentor, develop and train team members to facilitate career growth
Track and trend performance of team members
Educate credentialing and other appropriate team members (clinical and operational) on payor and plan credentialing nuances
Plan and strategize mid to longer term credentialing team needs to support PDS Health’s growth
In partnership with the Director, Business Process Outsource (BPO), determine the most effective allocation of work effort between the core PDS Health credentialing team and our BPO partners
In concert with other PDS Health leaders, optimize the credentialing process, including partnering with delegated credentialing committee and insurance payers to maximize delegating credentialing
Analyze overall and individual insurance payor trends to make recommendations on workflow improvements. Ensure all capabilities of PDS Health’s credentialing software (Credential Stream) and other software technologies and automation tools (i.e. UI Path) are fully exploited
Set agreed upon Key Performance Indicator (KPI) and Service Level (SLA) metrics. Ensure these are achieved by partnering with Director, BPO and being regularly reported
Oversee credentialing software/database systems (e.g., CAQH, PECOS, internal platforms)
Develop and improve standard operating procedures (SOPs)
Facilitate credentialing team’s coordination and communication related to the onboarding of new clinicians with other departments, including Legal, Recruiting, People Services, IT, Learning Development, and operational field leaders
Oversee and provide subject matter expertise on the development and maintenance of training programs, manuals, and all field / clinician facing collateral
Ensure PDS follows all regulatory compliance rules by maintaining all doctor’s credentials and licenses
Ensure alignment with and maintenance of audit procedures and delegated payor audits, including process adherence, document tracking, records, reports, policies and procedures for accuracy and effectiveness
Stay updated on trends that may impact payors, plans, and the credentialing process (i.e. credentialing alternatives, business or technology partners, competitors, new plan designs, etc.)
Other duties as assigned
Qualification
Required
5+ years of credentialing experience in a healthcare or insurance environment in lieu of a Bachelor's degree
2-3 years of management/supervisory experience in a credentialing or provider enrollment setting
Strong knowledge of payer processes for enrollment, re-credentialing, and revalidation
Experience in assessing workflow, leading a team, mentoring, coaching, and training subordinates
Preferred
Experience in a mid-to-large multi-site medical or dental support organization (MSO / DSO)
Experience with Medicare, Medicaid, and commercial payer enrollment is often required
Understanding of licensure, malpractice insurance, NPI, DEA, and provider credential documents
Certified Provider Credentialing Specialist (CPCS)
Other healthcare compliance or administration certifications
Experience with Credentialing software applications and/or general provider/payor enrollment procedures
Benefits
Medical, dental, and vision insurance
Paid time off
Tuition Reimbursement
401K
Paid time to volunteer in your local community
Company
PDS Health
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.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
SMILE Health
2023-08-08Non Equity Assistance
Leadership Team
Stephen Thorne
Founder & CEO
Jeremy Jonckheere
Vice President, Strategic Payor Partnerships
Recent News
New Orleans CityBusiness
2025-09-03
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