Credentialing & Payor Enrollment Supervisor

Ensemble Health Partners

1d•$69,400 - $104,100•Hybrid

About The Position

The Credentialing & Payor Enrollment Supervisor leads daily credentialing and payor enrollment operations to support timely provider readiness, payer participation, and compliance with applicable regulatory, accreditation, payer, and internal requirements. This role supervises credentialing specialists, monitors operational performance, ensures accurate provider data and documentation, and supports completion of credentialing, recredentialing, enrollment, revalidation, maintenance, delegated roster, and related payer activities. The Supervisor serves as an escalation point for complex or high-risk items and supports continuous improvement of quality, timeliness, and audit readiness across the function. The Credentialing & Payor Enrollment Supervisor oversees execution of credentialing and payor enrollment activities across provider, group, and facility workflows. This role manages work queues and operational priorities, supervises team performance, monitors quality and compliance standards, and collaborates with internal stakeholders, clients, and payer representatives to ensure accurate and timely credentialing and enrollment outcomes. The Supervisor promotes process consistency, maintains audit-ready documentation, and ensures adherence to regulatory, accreditation, payer, delegated credentialing, and internal policy requirements.

Requirements

Provider credentialing, recredentialing, payor enrollment, and provider lifecycle processes.
Governmental and commercial payer requirements related to provider participation and enrollment.
Healthcare regulatory, accreditation, and delegated credentialing requirements affecting credentialing and enrollment operations.
Provider data management, credentialing, enrollment, and documentation
Delegated credentialing, payer roster, provider group, and facility enrollment processes.
Operational performance measurement, quality assurance, audit readiness, and compliance control methodologies.
Team leadership, coaching, and employee development.
Workflow coordination and operational process management.
Issue resolution, risk identification, and escalation management.
Data analysis, reporting, and operational monitoring.
Quality assurance, documentation review, and audit support.
Cross-functional communication, stakeholder coordination, and follow-through.
Prioritize multiple operational demands in a fast-paced and deadline-driven environment.
Interpret complex payer, regulatory, accreditation, and delegated credentialing requirements.
Build effective relationships with internal teams, clients, providers, and payer representatives.
Communicate clearly across varying organizational levels and functional areas
Identify operational risks and support corrective action or process improvement plans.
Drive accountability for quality, compliance, timeliness, audit readiness, and service performance.
Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI.
Bachelor's degree in Healthcare Administration, Business Administration, Revenue Cycle Management, or related field; equivalent combination of education and experience may be considered.
Minimum 5 years of provider credentialing, payor enrollment, or closely related healthcare operations experience.
Minimum 2 years of direct leadership, supervisory, or team lead experience.
Experience working with commercial and governmental payer credentialing or enrollment processes.
Experience utilizing provider credentialing, enrollment, or provider data management systems.
Demonstrated knowledge of healthcare regulatory, accreditation, payer, or delegated credentialing requirements impacting provider credentialing and enrollment operations.

Nice To Haves

Experience supporting delegated credentialing environments.
Experience working with NCQA standards and accreditation requirements.
Experience supporting multi-state provider, group, or facility credentialing and payor enrollment activities.
Experience leading credentialing or payor enrollment operations within a centralized shared services environment.
Professional certification related to credentialing, provider enrollment, healthcare operations, or revenue cycle management.

Responsibilities

Supervise daily provider credentialing and payor enrollment operations and workflow activities.
Lead and develop Provider Credentialing Specialists through coaching, training, performance management, and workload coordination.
Oversee credentialing, recredentialing, initial enrollment, revalidation, maintenance, termination, group enrollment, facility enrollment, and ownership change activities.
Monitor credentialing and enrollment status, aging reports, work queues, payer follow-up, and application progress to support timely completion of requirements.
Investigate and resolve complex credentialing, enrollment, payer, data, documentation, and operational escalations.
Ensure accurate maintenance of provider credentialing and enrollment information within designated systems and databases.
Coordinate credentialing and enrollment activities with medical staff, revenue cycle, operations, clients, payer representatives, and other cross-functional partners.
Ensure compliance with payer requirements, CMS guidelines, NCQA standards, delegated credentialing requirements, applicable regulations, and internal policies.
Maintain complete, accurate, and audit-ready documentation for credentialing and enrollment activities.
Perform quality reviews and routine audits to promote accuracy, consistency, compliance, and process improvement.
Support delegated roster submission, receipt confirmation, payer approval follow-up, and related documentation requirements.
Analyze operational performance metrics and identify opportunities to improve efficiency, quality, service delivery, and provider readiness outcomes.
Support implementation of standard work procedures, process improvements, quality controls, and best practices.
Maintain awareness of regulatory, accreditation, payer, and industry changes impacting provider credentialing and payor enrollment operations.
Prepare reporting and status updates for leadership regarding operational performance, credentialing and enrollment progress, risks, and escalations.