Credentialing & Payor Enrollment Supervisor
Core
Leads daily credentialing and payor enrollment operations to support timely provider readiness, payer participation, and compliance with regulatory and payer requirements.
Role type
Senior IC healthcare operations supervisor (credentialing & payor enrollment)
Builds
Provider credentialing, recredentialing, initial enrollment, revalidation, maintenance, termination, group enrollment, and facility enrollment workflows
Domain
Healthcare revenue cycle management
Required skills
Provider credentialing lifecycle management, payor enrollment processes, healthcare regulatory compliance, team leadership, operational performance monitoring, data analysis, quality assurance, audit readiness, stakeholder coordination, risk identification
Preferred skills
Delegated credentialing experience, NCQA standards knowledge, multi-state credentialing experience
Technologies
Provider credentialing and enrollment systems, data management databases
Responsibilities
Supervise daily provider credentialing and payor enrollment operations and workflow activities; Lead and develop Provider Credentialing Specialists through coaching, training, performance management, and workload coordination; Oversee credentialing, recredentialing, initial enrollment, revalidation, maintenance, termination, group enrollment, facility enrollment, and ownership change activities; Monitor credentialing and enrollment status, aging reports, work queues, payer follow-up, and application progress; Investigate and resolve complex credentialing, enrollment, payer, data, documentation, and operational escalations; Ensure accurate maintenance of provider credentialing and enrollment information within designated systems and databases; Coordinate credentialing and enrollment activities with medical staff, revenue cycle, operations, clients, payer representatives, and other cross-functional partners; Ensure compliance with payer requirements, CMS guidelines, NCQA standards, delegated credentialing requirements, applicable regulations, and internal policies; Maintain complete, accurate, and audit-ready documentation for credentialing and enrollment activities; Perform quality reviews and routine audits to promote accuracy, consistency, compliance, and process improvement; Support delegated roster submission, receipt confirmation, payer approval follow-up, and related documentation requirements; Analyze operational performance metrics and identify opportunities to improve efficiency, quality, service delivery, and provider readiness outcomes; Support implementation of standard work procedures, process improvements, quality controls, and best practices; Maintain awareness of regulatory, accreditation, payer, and industry changes impacting provider credentialing and payor enrollment operations; Prepare reporting and status updates for leadership regarding operational performance, credentialing and enrollment progress, risks, and escalations
Seniority
Senior, hands-on IC with leadership responsibilities