Mgr Network Compliance & QA

Health Care Service Corporation
life insurance, parental leave, paid time off, paid holidays, tuition reimbursement, 401(k)
United States, Michigan, Southfield
25925 Telegraph Road (Show on map)
Dec 19, 2024
At Dearborn, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. 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 Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Dearborn, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, a minimum of 15 days' of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time employees. The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan. Dearborn Group 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