Provider Credentialing Supervisor
About The Position
The Provider Credentialing Specialist serves as the operational subject matter expert (SME) supporting the design, implementation, and ongoing development of a government healthcare credentialing program. This role partners with government stakeholders, business teams, and technical resources to translate operational requirements into scalable credentialing workflows while ensuring compliance with CMS, NCQA, organizational policies, and regulatory requirements. The position is responsible for implementation activities, provider credentialing operations, primary source verification (PSV), committee preparation, workflow documentation, and serving as the primary operational contact for government clients regarding credentialing processes.
Requirements
- 3 + years of related experience
- Documentation Review
- Document Reporting (Inactive)
- Operational Requirements
- Standard Operating Procedure (SOP)
- MBI (T2) clearance
Nice To Haves
- Provider Credentialing Specialist Lead
Responsibilities
- Serve as the primary operational contact for government stakeholders regarding credentialing operations.
- Support implementation activities for new credentialing processes and system enhancements.
- Document business requirements and translate operational workflows for technical teams.
- Perform initial credentialing and recredentialing activities.
- Complete Primary Source Verification (PSV) for all required credentialing elements.
- Review provider applications for completeness and compliance.
- Prepare credentialing files for committee review.
- Ensure credentialing files meet organizational, CMS, and NCQA standards.
- Develop and maintain standard operating procedures (SOPs).
- Participate in workflow design and process improvement initiatives.
- Assist with User Acceptance Testing (UAT) during system implementations.
- Identify workflow gaps and recommend operational improvements.
- Collaborate with cross-functional teams including IT, compliance, operations, and government stakeholders.
- Maintain credentialing documentation and audit readiness.
- Monitor credentialing timelines and ensure compliance with established turnaround times.
Benefits
- Medical plan options
- Health Savings Accounts
- Dental plan options
- Vision plan
- 401(k) plan with company match
- Flexible work weeks
- Paid time off (vacation, sick, personal)
- Holidays
- Paid parental leave
- Military leave
- Bereavement leave
- Jury duty leave
- Short-term disability benefits
- Long-term disability benefits
- Life insurance
- Accidental death and dismemberment insurance
- Personal accident insurance
- Critical illness insurance
- Business travel and accident insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
