Description
Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.
DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.
Job Description:
Location: Must reside in Oklahoma
The opportunity :
The Manager, Provider Enrollment & Credentialing is responsible for managing and monitoring staff and systems that guide the accurate and timely tracking and monitoring of provider-related enrollment and credentialing activities.
How you will contribute:
- Oversee enrollment and credentialing of Providers following requirements (NCQA, CMS, DDPA, etc.).
- Collaboratively work with Quality Assurance to ensure an effective audit process, which will result in the ability to develop staff training content.
- Ensure the company's processes meet client expectations, Federal and state regulations.
- Assist with credentialing audits as needed.
- Ensure all Applications are tracked.
- Manage staff members to ensure high-performing teams
- Complete necessary reporting to ensure staff members are completing work within the established TAT and accuracy.
- Complete necessary reporting to ensure staff members are meeting productivity requirements.
- Production of monthly staff member scorecards.
- Train and motivate team members.
- Conduct monthly one-on-one sessions for coaching and mentoring.
- Write and deliver corrective action plans when appropriate.
- Create a culture that embraces the company's vision, mission, and goals.
- Continuously evaluate resources to ensure they are appropriately allocated to meet all Provider Operations deadlines and required outcomes.
- Implement, monitor, and maintain process changes resulting from corrective action plans.
- Identify issues and inefficiencies to make recommendations for process improvements.
- Resolve complaints and issues with providers.
- Engage and maintain relationships with internal customers to ensure provider satisfaction.
- Serve as a SME to advise our internal and external customers to proactively meet customer needs.
- Coordinate and implement appropriate performance management strategies for team members to include:
- Actively participates in the hiring process, including interviewing candidates.
- Actively participate in the preparation of performance and wage evaluations per company policy.
- Monitor and manage attendance and company-approved time off for team members.
- Update the management team timely manner on any concerns or issues.
- Other duties as assigned.
What you will bring with you:
- Bachelor's degree in Health Care or relevant field, preferred.
- 3+ years of supervisory experience required.
- Knowledge of NCQA, URAC & CMS, and other quality requirements preferred.
- Excellent PC skills with proficiency in MS Office products.
- Excellent oral and written communication skills.
- Strong customer service and reasoning skills.
- Strong Project management and process improvement skills.
- Ability to manage staff and work well with others.
- Ability to prioritize and organize multiple tasks and remain organized with multiple interruptions.
- Ability to meet multiple deadlines.
- Ability to work more than 40 hours per week, as needed or required to meet business objectives.
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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.
Life is brighter when you work at Sun Life
At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work® Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.
We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
We do not require or administer lie detector tests as a condition of employment or continued employment.
Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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