Credentialing Supervisor

JOB SUMMARY

The Credentialing Supervisor exists to protect patient safety and revenue flow by ensuring all healthcare providers meet rigorous compliance, state, and regulatory standards. Operating at the intersection of clinical compliance and revenue operations, this role directly accelerates provider onboarding, prevents billing delays, and mitigates legal risk. By reviewing credentials, maintaining audit-ready records, and liaising between providers and internal teams, the Specialist ensures seamless managed care enrollment. Ultimately, this position maintains the organization's operational integrity and high standard of care.

Mission, Culture & Values

At the company the company, we believe exceptional employee experiences create exceptional client experiences. Our culture is built on collaboration, continuous improvement, accountability, and care.

We care for our customers, we care for our employees, and we care for one another. Every team member plays an important role in creating an environment where people feel respected, supported, empowered to grow, and inspired to do meaningful work.

What You’ll Do

Initial Credentialing and Recredentialing of Reviewers

• Enters reviewer application data, performs online searches of reviewers, and conducts primary source verification of reviewer board certifications, licenses, background checks, and malpractice checks. Uploads documents to the electronic reviewer file, produces judgments page to include comments from the Medical Director. Applies client Do Not Use status as required.

• Communicates the application status with the operations team, including when an application is denied by the Medical Director.

Updating Expired Licenses, Board Certifications, and Workers’ Compensation Registration

• Reviews licenses, certifications, and registrations for expiration status.

Reactivating, Deactivating, Do Not Use, Reviewer Contact Data, and W9 Requests

• Obtains W-9 documents in response to address changes.

• Clones profiles in the event of a fundamental identifying data change.

• Removes reviewers from the panel based on client or Operations department requests.

Editing Fee Schedules

• Performs data entry of new fees or updated fees.

• Obtains new fee agreements as appropriate.

Participation on the Quality Management Committee

• Participates in the Quality Management Committee meetings.

Assist the company the company Team Members with Credentialing Content

• Provides credentialing-related advice to leadership and for contracting and Operations functions.

Functional Supervision of Credentialing Specialists

• Coordinates the day-to-day assignments and activities of the Credentialing team members, including training and instruction.

Other duties

What Makes This Role Successful

• Operating with a Quality & Compliance First Mindset: Prioritizing zero-compromise reviewer compliance and audit readiness. You proactively safeguard patient safety and client trust by ensuring 100% accuracy in primary source verifications, licensure updates, and Quality Management Committee reporting.

• Accelerating Revenue Operations & Onboarding: Driving speed-to-panel without sacrificing regulatory integrity. You streamline intake and verification processes to eliminate onboarding bottlenecks, ensuring reviewers are active and billable as quickly as possible.

• Fostering Team Accountability & Growth: Coaching and functionally supervising Credentialing Specialists with clarity, empathy, and constructive feedback. You build an empowered, highly efficient team that lives the company the company’s culture of caring for one another and striving for continuous improvement.

• Bridging Cross-Functional Collaboration: Serving as a trusted subject-matter expert for Medical Directors, Operations, Legal, and Contracting. You communicate credentialing statuses, denials, and Do Not Use (DNU) flags transparently to keep all stakeholders aligned.

• Thinking Beyond the Task: Continuously evaluating day-to-day credentialing workflows, identifying operational friction points, and implementing standardizations that improve quality, accuracy, and cycle times across the panel.

What Your First 90 Days May Look Like

• First 30 Days (Learn & Audit): Master systems, shadow specialists, build cross-functional relationships with Operations and Medical Directors, and audit current credentialing logs to establish operational baselines.

• First 31–60 Days (Lead & Standardize): Take full ownership of daily team coordination, actively participate in Quality Management Committee meetings, and tighten tracking for expiring licenses and fee schedule updates.

• First 61–90 Days (Optimize & Scale): Implement process improvements to reduce reviewer onboarding cycle times, establish team training guides, and ensure all electronic reviewer files are 100% audit-ready.

Requirements

EDUCATION/CREDENTIALS

• An Associate’s Degree or Bachelor’s Degree is preferred.

Must Haves

• Business experience in a healthcare and/or insurance setting is preferred. Credentialing experience is a must.

Preferred Qualifications

• Present exceptional communication skills with a clear understanding of company business lines.

• The ability to apply critical thinking, manage time efficiently and meet specific deadlines.

• Computer literacy and typing skills are essential.

WORKING CONDITIONS/PHYSICAL DEMANDS

Any lifting, bending, traveling, etc. required to do the job duties listed above. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role. Examples:

• Prolonged periods sitting or remaining stationary at a desk and working on a computer.

• Constant operation of a computer, keyboard, mouse, and other digital productivity tools.

• Close visual acuity required to view computer screens, analyze data, and read extensive digital documentation.

• Frequent communication with team members, leadership, and external partners via email, chat, phone, and video conferencing platforms.

• Occasional moving or positioning of office equipment or files weighing up to 10–15 pounds.

Why Join the company the company?

• Collaborative remote culture

• Professional growth opportunities

• Meaningful work supporting the healthcare industry

• Comprehensive benefits

• Great Place to Work Certified since 2021

• Commitment to employee development

WORK FROM HOME TECHNICAL REQUIREMENTS

Supply and support their own internet services.

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Equal Opportunity Statement

At the company the company, caring for people is at the heart of what we do. We are committed to creating an inclusive workplace where every employee feels respected, valued, and empowered to contribute. We provide equal employment opportunities to all applicants and employees and make employment decisions based on qualifications, merit, business needs, and without regard to race, color, religion, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other characteristic protected by applicable federal, state, or local law.

This job description is subject to change at any time.

Benefits

Join our team at the company the company and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.

ABOUT the company the company

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.