Supervisor, Credentialing

JOB SUMMARY:

The Credentialing Supervisor is responsible for the oversight, management, compliance, and administration of provider, facility, and entity-level (re)credentialing, privileging, and payer enrollment activities for Chase Brexton Health Services. This position ensures compliance with HRSA (re)credentialing and privileging requirements, payer requirements, and organizational policies. The role supervises a team responsible for provider, facility, and entity-level (re)credentialing/, payer enrollment, privileging, and ongoing compliance activities.

MAJOR DUTIES AND RESPONSIBILITIES:

Performance Management

• Supervise credentialing staff, including scheduling, payroll, evaluations, coaching, and corrective action
• Maintain competencies and departmental performance metrics

Resource, Staff, and Budget

• Recruit, onboard, train, and develop staff

Analytical and Critical Thinking

• Oversee initial and ongoing provider credentialing and recredentialing.
• Collect and review privileging documents.
• Coordinate initial privileging and re-privileging processes.
• Oversee facility, group, and provider enrollment with Medicare, Medicaid, and commercial payers.
• Maintains active payer enrollments, profiles, certifications, and completes revalidations and updates to ensure uninterrupted billing and operational status.

Compliance, Policy, and Procedure

• Ensure primary source verification and maintenance of credentialing files
• Ensure approvals are completed through established organizational pathways.
• Maintain compliance with HRSA credentialing and privileging requirements.
• Support audits, Operational Site Visits, and regulatory reviews.

Communication

• Work directly with providers to obtain required documentation
• Alert leadership to any issues related to facility or individual provider credentialling.

Workplace Computers and Equipment

• Utilize CredentialStream and CAQH to maintain provider records and workflows.
• Generate reports and monitor enrollment and credentialing status.

SKILLS AND ABILITIES:

Knowledge of HRSA credentialing requirements, payer enrollment processes, CAQH, CredentialStream, healthcare regulations, leadership, communication, organization, and compliance management.

EDUCATION AND/OR EXPERIENCE:

Required

• Associate degree in Healthcare Administration, Business Administration, Health Information Management, or related field.
• Minimum five (5) years of experience in provider credentialing, privileging, and payer enrollment.
• Experience with HRSA credentialing and privileging requirements.
• • with CAQH and CredentialStream or similar systems.
• CPCS certification.

Preferred

• Previous supervisory experience.
• Bachelor degree in related field.
• FQHC experience.

WORKING CONDITIONS/PHYSICAL DEMANDS:

Work is typically performed in an office environment.