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.