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.

Read the original listing on workforcenow.adp.com