Credentialing & Payor Analytics Manager

Mercy Dental Group is currently hiring for a full-time Credentialing & Payor Analytics Manager to add to our amazing team! As part of the Mercy Dental Group family, our mission is to help families experience compassionate, community-focused, and extraordinary oral healthcare throughout each of our offices. We focus on helping our team members build practices that change lives and communities by delivering better care and dentistry. Please visit our website below to learn more about our mission and values!

https://www.mercydentalwi.com/

Along with our website, please visit our Facebook page to see all of the exciting updates from our offices every week!

The Credentialing & Payor Analytics Manager is responsible for overseeing the provider credentialing process, managing payer contract negotiations, and performing financial analytics on reimbursements. This role ensures timely provider enrollment, maintains payer compliance, and leverages data analytics to optimize reimbursement rates and minimize underpayments.

Key Responsibilities

1. Credentialing & Compliance Management

• Oversee and manage credentialing and re-credentialing for all providers across 10 locations
• Ensure timely submission and approval of CAQH, NPI, DEA, state licensure, and insurance enrollments
• Maintain an up-to-date credentialing database, tracking all provider enrollment statuses and deadlines
• Work with insurance carriers to resolve credentialing delays, disputes, and denials

2. Insurance Contract & Fee Schedule Analysis

• Maintain payer fee schedules, tracking reimbursement rates across all insurance providers
• Analyze insurance contract terms and reimbursement trends, identifying opportunities for renegotiation
• Work closely with leadership to evaluate payer participation and recommend contract changes
• Ensure payer compliance with agreed-upon rates, tracking any discrepancies in payments

3. Reporting & Auditing for Payor Performance

• Develop and manage monthly KPI reports for credentialing turnaround times, payer performance, and adjustments
• Audit insurance reimbursements to identify underpayments and ensure compliance with negotiated fee schedules
• Monitor adjustment rates, denials due to credentialing, and insurance write-offs
• Work with the billing and revenue cycle teams to address credentialing-related claim denials

4. Payor Relations & Contract Negotiations

• Serve as the primary point of contact for payer representatives and network negotiations
• Collaborate with payers to improve reimbursement rates and contract terms
• Stay informed on policy changes, credentialing requirements, and regulatory compliance
• Support the appeals and disputes process to recover lost revenue from credentialing issues

5. Process Improvement & Technology Utilization

• Implement automation tools to improve the efficiency of the credentialing and contract management process
• Utilize Jarvis Analytics, Dentrix Ascend, and credentialing platforms to track and analyze payer data
• Develop SOPs (Standard Operating Procedures) for credentialing, payer audits, and reporting workflows

Qualifications

Education & Experience

• Bachelor’s degree or equivalent experience in Dental/Healthcare Administration, or a related field
• 3 years of experience in provider credentialing, payer relations, contract negotiations, or revenue cycle management in a multi-location DSO or healthcare setting (preferred)
• Strong understanding of insurance reimbursements, dental payer contracts, and credentialing workflows
• Experience with Dentrix Ascend, Jarvis Analytics, CAQH ProView, and payer portals (preferred, but will train the right candidate)

Skills & Competencies

Analytical mindset: Ability to analyze reimbursement trends and identify contract optimization opportunities

Attention to detail: Strong organizational skills for tracking provider enrollment and payer contracts

Problem-solving: Experience resolving credentialing-related claim denials and negotiating payer contracts

Communication skills: Ability to liaise with payers, internal teams, and providers professionally and effectively

Tech-savvy: Comfortable using credentialing and analytics software to automate workflows

Salary:

• $60,000/yr - $70,000/yr
• Based on experience
• Professional development opportunities in payer analytics and RCM

Benefits Include:

1.) All-Expenses Paid Tropical Vacation After 5 Years with Mercy Dental Group!!

• Includes you and a guest
• Would be eligible for this benefit every 5 years! (5 years, 10 years, 15 years, etc.)

2.) Paid Time Off

3.) Various Insurances!

• Matched 401(k)
• Medical
• Dental
• Vision
• Health Savings Account/Flexible Spending Account
• Life Insurance
• Short-term Disability
• Accidental, Cancer, and Hospital coverages

Salary : $60,000 - $70,000