Credentialing & Payor Enrollment Supervisor

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $69.4k - $104.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Ensemble Health Partners

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Private Equity Round on 2022-03

Consulting • Insurance • Logistics

Ensemble Health Partners is a leading provider of revenue cycle management (RCM) services for healthcare organizations. They offer an end-to-end RCM solution that helps hospitals, health systems, and affiliated physician groups optimize their revenue cycles, reduce denials and underpayments, and enhance patient experiences using a combination of expert management and advanced technology. Ensemble Health Partners leverages certified operators and AI to deliver consistent results, improve collections, and support future growth for healthcare providers. They are recognized for their robust client partnerships and commitment to delivering reliable revenue lift and cost savings for their clients.

📋 Description

• Lead daily credentialing and payor enrollment operations across provider, group, and facility workflows • Supervise, coach, train, and manage Provider Credentialing Specialists • Coordinate workloads, work queues, operational priorities, and team performance • Oversee credentialing, recredentialing, initial enrollment, revalidation, maintenance, termination, group enrollment, facility enrollment, and ownership change activities • Monitor status, aging reports, payer follow-up, and application progress • Investigate and resolve complex credentialing, enrollment, payer, data, documentation, and operational escalations • Maintain accurate provider credentialing and enrollment information in designated systems and databases • Coordinate with medical staff, revenue cycle, operations, clients, payer representatives, and cross-functional partners • Ensure compliance with payer requirements, CMS guidelines, NCQA standards, delegated credentialing requirements, regulations, and internal policies • Maintain complete, accurate, and audit-ready documentation • Perform quality reviews and routine audits • Support delegated roster submissions, receipt confirmation, payer approval follow-up, and related documentation • Analyze operational metrics and identify process improvement opportunities • Support standard work procedures, quality controls, and best practices • Monitor regulatory, accreditation, payer, and industry changes • Prepare leadership reports and status updates on performance, progress, risks, and escalations

🎯 Requirements

• 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 with commercial and governmental payer credentialing or enrollment processes • Experience utilizing provider credentialing, enrollment, or provider data management systems • Knowledge of healthcare regulatory, accreditation, payer, or delegated credentialing requirements • Willingness and ability to travel to and work onsite at client, temporary, or corporate office locations as business needs require • Must reside in and be authorized to work within the United States • Experience supporting delegated credentialing environments preferred • Experience with NCQA standards and accreditation requirements preferred • Experience supporting multi-state provider, group, or facility credentialing and payor enrollment activities preferred • Experience leading credentialing or payor enrollment operations within a centralized shared services environment preferred • Professional certification related to credentialing, provider enrollment, healthcare operations, or revenue cycle management preferred • Demonstrated advanced usage of AI and management of teams using AI for process and technological improvements

🏖️ Benefits

• Bonus Incentives • Paid Certifications • Tuition Reimbursement • Comprehensive Benefits including healthcare, time off, retirement, and well-being programs • Career Advancement • Professional certification relevant to the associate’s field • Quarterly and annual incentive programs • Work-Life Flexibility • Professional development