Supv. Payer Relations-Payor Contracting

Summary

Job Summary

The Supervisor of Payer Relations supervises all aspects of payer enrollment and physician credentialing processes to ensure timely and accurate provider participation with insurance networks. Supervises the payer enrollment teams, maintains compliance with payer requirements, and works cross-functionally with revenue cycle, contracting, and provider relations teams to ensure smooth onboarding and maintenance of provider enrollments.

Minimum Job Requirements:

Work Experience:

Three years of experience in payer enrollment or credentialing within a hospital or healthcare system required. Strong knowledge of CMS, Medicaid, and commercial payer requirements.

One year of management experience required.

License/Registration/Certification:

None

Education and Training:

Bachelor’s degree in Healthcare Administration, Business, or related field required.

Skills:

1. Comprehensive knowledge of payer enrollment, revalidation, and provider credentialing processes across Medicare, Medicaid, and commercial payers.
2. Knowledge of federal and state regulations, CMS requirements, accreditation standards, and payer‑specific enrollment guidelines.
3. Knowledge of credentialing and enrollment systems, including PECOS, TMHP, NPPES, CAQH, and payer portals.
4. Knowledge of revenue cycle dependencies, provider activation workflows, and the impact of enrollment on billing and reimbursement.
5. Skill in supervising and leading staff, including training, coaching, performance feedback, and workload management.
6. Skill in developing, implementing, and standardizing payer enrollment and credentialing processes and workflows.
7. Skill in overseeing high‑volume application submission, tracking, follow‑up, and issue resolution activities.
8. Skill in auditing enrollment and credentialing files to ensure accuracy, completeness, and audit readiness.
9. Skill in preparing, analyzing, and presenting reports, dashboards, and performance metrics related to productivity, turnaround times, and approvals.
10. Skill in identifying operational gaps and implementing process improvements and system enhancements.
11. Ability to manage multiple priorities, deadlines, and escalations in a complex, regulated healthcare environment.
12. Ability to collaborate cross‑functionally with Contracting, Billing, Provider Relations, Medical Staff Services, and Compliance teams.
13. Ability to serve as the primary point of contact for payer enrollment inquiries, escalations, and external coordination.
14. Ability to communicate clearly and professionally with staff, leadership, providers, and payer representatives, including educating stakeholders on timelines and requirements.
15. Ability to ensure staff compliance with organizational policies, payer requirements, regulatory standards, and confidentiality obligations while contributing to departmental planning and policy development.