Credentialing & Payor Enrollment Supervisor

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Direct daily operations for credentialing and payor enrollment across provider, group, and facility workflows.

• Manage, coach, and train Provider Credentialing Specialists.

• Organize workloads, work queues, operational priorities, and evaluate team performance.

• Supervise credentialing, recredentialing, initial enrollment, revalidation, maintenance, termination, group enrollment, facility enrollment, and ownership change activities.

• Track status, aging reports, payer follow-up, and application progress.

• Investigate and resolve intricate credentialing, enrollment, payer, data, documentation, and operational escalations.

• Ensure accurate maintenance of provider credentialing and enrollment data in specified systems and databases.

• Collaborate with medical staff, revenue cycle, operations, clients, payer representatives, and cross-functional partners.

• Ensure adherence to payer requirements, CMS guidelines, NCQA standards, delegated credentialing requirements, regulations, and internal policies.

• Maintain comprehensive, precise, and audit-ready documentation.

• Conduct quality reviews and regular audits.

• Assist with delegated roster submissions, receipt confirmation, payer approval follow-up, and related documentation.

• Analyze operational metrics to identify opportunities for process enhancement.

• Support standard operating procedures, quality controls, and best practices.

• Observe regulatory, accreditation, payer, and industry changes.

• Generate leadership reports and status updates concerning performance, progress, risks, and escalations.

⛳️ Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, Revenue Cycle Management, or a related field; equivalent combinations of education and experience may be accepted.

• At least 5 years of experience in provider credentialing, payor enrollment, or closely related healthcare operations.

• Minimum of 2 years in a direct leadership, supervisory, or team lead role.

• Familiarity with commercial and governmental payer credentialing or enrollment processes.

• Experience with provider credentialing, enrollment, or provider data management systems.

• Understanding of healthcare regulatory, accreditation, payer, or delegated credentialing requirements.

• Willingness and capability to travel and work onsite at client, temporary, or corporate office locations as business needs dictate.

• Must reside in and possess authorization to work within the United States.

• Experience in supporting delegated credentialing environments is preferred.

• Familiarity with NCQA standards and accreditation requirements is preferred.

• Experience in multi-state provider, group, or facility credentialing and payor enrollment activities is preferred.

• Proven experience leading credentialing or payor enrollment operations within a centralized shared services environment is preferred.

• Professional certification relevant to credentialing, provider enrollment, healthcare operations, or revenue cycle management is preferred.

• Demonstrated advanced usage of AI and management of teams utilizing AI for process and technological improvements.

🏝️ Benefits

• Bonus Incentives

• Paid Certifications

• Tuition Reimbursement

• Comprehensive Benefits including healthcare, time off, retirement, and well-being programs

• Career Advancement

• Professional certification relevant to the associate’s field

• Quarterly and annual incentive programs

• Work-Life Flexibility

• Professional development