Credentialing & Payor Enrollment Supervisor

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,monitorsquality and compliance standards, and collaborates with internal stakeholders, clients, and payer representatives to ensureaccurateandtimelycredentialing and enrollment outcomes. The Supervisor promotes process consistency,maintainsaudit-ready documentation, and ensures adherence to regulatory, accreditation, payer, delegated credentialing, and internal policy requirements.

Key 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 supporttimelycompletion of requirements.
• Investigate and resolve complex credentialing, enrollment, payer, data, documentation, and operational escalations.

• Ensureaccuratemaintenance 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.

• Maintaincomplete,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 andidentifyopportunities to improve efficiency, quality, service delivery, and provider readiness outcomes.

• Support implementation of standard work procedures, process improvements, quality controls, and best practices.
• Maintainawareness of regulatory, accreditation, payer, and industry changesimpactingprovider credentialing and payor enrollment operations.

• Prepare reporting and status updates for leadershipregardingoperational performance, credentialing and enrollment progress, risks, and escalations.