PRIMARY FUNCTION

The Delegated Credentialing Supervisor oversees the end‑to‑end delegated credentialing and enrollment process, ensuring full compliance with NCQA, AAAHC, and payer requirements while maintaining accurate provider data and supporting timely onboarding, offboarding, and renewals. This role provides leadership to credentialing staff, manages internal and external audits, serves as a liaison with delegated entities and internal partners, and drives continuous process improvement to enhance quality, efficiency, and operational performance.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

 

Supervise and develop credentialing staff, including assigning workloads, providing coaching and feedback, and supporting ongoing training and performance development.

 

Oversee daily delegated and non‑delegated credentialing and enrollment activities, ensuring timely processing of enrollments, re‑enrollments, and related updates.

 

Ensure compliance with state, federal, accreditation, and payer requirements by conducting internal audits, coordinating external audits, and monitoring monthly reporting for accuracy and completeness.

 

Maintain and manage credentialing and enrollment data across all systems, ensuring provider records, rosters, and documentation are accurate, current, and consistently updated.

 

Serve as a primary liaison with payers, delegated entities, internal partners, and providers to address credentialing and enrollment inquiries, resolve issues, and support smooth operational workflows.

 

Identify and implement process improvements, including technological enhancements and workflow optimizations, to increase efficiency, accuracy, and overall departmental performance.

 

 

 

SUPERVISORY RESPONSIBILITIES

Provides direct supervision to Credentialing Specialists, including workflow coordination, performance support, and training.

 

QUALIFICATIONS

EDUCATION: Bachelor’s degree required; proven relevant experience may be accepted in place of a degree.

 

EXPERIENCE: Minimum of three years of relevant experience in credentialing, enrollment, or a related healthcare operations field required with at least one year of experience in a leadership role with responsibility for leading or supervising staff.

 

KNOWLEDGE, SKILLS, AND ABILITIES

Experience in delegated credentialing and non‑delegated enrollment, with a solid understanding of end‑to‑end processes. Proven supervisory or leadership experience, including supporting staff development and managing workflow priorities. Strong knowledge of NCQA standards and applicable state and federal regulations governing credentialing and provider enrollment. Excellent organizational, communication, and problem‑solving skills, with the ability to manage multiple priorities in a fast‑paced environment. Proficiency with credentialing software and the Microsoft Office Suite, including data entry, reporting, and documentation management. Familiarity with CredentialStream or similar credentialing platforms is preferred.

TYPICAL WORKING CONDITIONS

Non-patient facing Remote position Must be U.S. based. Requires extended periods of sitting, data entry, and screen time. Occasional standing, walking, or lifting of files and materials up to 10–15 pounds may be required. Regular interaction with internal staff, providers, payers, and external partners. Work may involve managing multiple priorities and deadlines in a fast‑paced setting.

 

OTHER PHYSICAL REQUIREMENTS

Vision Sense of sound Sense of touch

 

 

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.