[Hiring] Credentialing & Payor Enrollment Supervisor @Ensemble Health Partners

Role Description

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.

This role oversees execution of credentialing and payor enrollment activities across provider, group, and facility workflows. Responsibilities include managing work queues and operational priorities, supervising team performance, monitoring quality and compliance standards, and collaborating with internal stakeholders, clients, and payer representatives to ensure accurate and timely credentialing and enrollment outcomes.

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 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.

Qualifications

• 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.

Preferred Qualifications

• 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.

Benefits

• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement