Supervisor of Revenue Cycle and Credentialing

MAJOR FUNCTION

The Supervisor of Revenue Cycle and Credentialing works under the direction of the Director of Revenue Cycle and Credentialing to oversee daily revenue cycle and provider credentialing operations, ensuring accurate billing, timely payer enrollment, reimbursement integrity, and compliance with federal, state, payer, HRSA, and NCQA requirements. This position provides leadership and oversight of Revenue Cycle and Credentialing staff and supports efficient workflows across Medical, Dental, Behavioral Health, and ancillary service lines. The Supervisor monitors billing, collections, audits, credentialing, recredentialing, payer enrollment, denial trends, Medicaid WRAP activity, LOA (NJ state letter of agreement) billing processes, and reimbursement performance while supporting workflow optimization within Dental and Medical EMR or software platforms Working collaboratively with Patient Access, Clinical Operations, Finance, IT, and external partners, the Supervisor identifies and resolves operational and reimbursement issues, promotes data integrity and reporting accuracy, and supports continuous process improvement to enhance organizational performance and revenue outcomes.

ESSENTIAL FUNCTIONS:

Supervisory

· Provide leadership, guidance, and oversight to revenue cycle and credentialing staff, promoting high performance, accountability, and professional development.

· Participate in cross-functional meetings related to reimbursement optimization, workflow improvement initiatives, and operational coordination efforts.

· Assist with implementation and monitoring of workflow standardization initiatives and departmental operational improvement projects.

· Support department quality assurance initiatives related to billing accuracy, reimbursement integrity, and credentialing compliance.

· Collaborate with Finance, Patient Access, Clinical Operations, Dental, Behavioral Health, and IT departments to support operational workflow improvements and reimbursement initiatives.

· These are additive operational responsibilities that are not already stated in the Supervisor job description.

· Assign duties, review work products, and ensure accuracy, efficiency, and adherence to departmental policies and procedures.

· Establish clear goals, expectations, and performance metrics for team members.

· Conduct regular performance evaluations and address performance issues promptly.

· Provide ongoing coaching, feedback, and training to enhance staff competencies and compliance.

· Foster a collaborative and positive work environment.

· Identify training needs and coordinate professional development opportunities for staff.

· Participate in strategic planning and departmental decision-making processes.

· Assist the Director of Revenue Cycle & Credentialing with development and implementation of internal controls, policies, and procedures.

Revenue Integrity

· Oversee billing, coding, collections, and denial management processes to ensure timely and accurate reimbursement.

· Monitor revenue cycle performance metrics, generate reports, and identify trends and opportunities for improvement.

· Provide analytical support to departments related to revenue cycle issues.

· Ensure compliance with HIPAA, CPT, ICD-10, Medicare, Medicaid, commercial payer, and local coverage determination requirements.

· Present audit findings and best practices to mitigate risk and improve documentation and reimbursement accuracy.

· Manage relationships with outsourced revenue cycle vendors.

· Work collaboratively with Patient Access (Medical and Dental) to resolve registration and billing issues.

· Oversee month-end and year-end close processes and support external financial and billing audits.

· Assist with review and follow-up of EMR claim edits, local rules, and workflow holds impacting claim submission and reimbursement timeliness.

· Monitor Behavioral Health, Dental, and Medical reimbursement trends to identify workflow gaps impacting reimbursement performance and encounter integrity.

· Support reconciliation of operational and billing reports to improve reporting accuracy and reimbursement tracking.

· Assist with monitoring Medicaid WRAP activity, Letters of Agreement (LOA) billing workflows, and payer reimbursement discrepancies.

· Participate in workflow optimization initiatives related to encounter closure, billing accuracy, denial prevention, and reimbursement turnaround times.

· Assist with tracking payer-specific reimbursement trends, denial patterns, underpayments, and takebacks and escalate concerns to leadership as appropriate.

· Support operational reporting initiatives related to AR aging, clean claim rates, denial trends, and reimbursement performance metrics.

· Coordinate with operational departments to resolve workflow issues impacting billing accuracy, reimbursement capture, and claim submission timeliness.

· Review and monitor patient demographic, insurance, and guarantor information between Dentrix and EMR to ensure data accuracy, consistency, and proper claim generation.

· Coordinate reconciliation efforts between Dental and Medical EMR or software platforms identify discrepancies impacting encounter integrity, billing accuracy, reporting, and reimbursement.

· Assist in identifying workflow or interface issues between Dental and Medical EMR or software platforms that may result in duplicate claims, missing encounters, claim holds, or reimbursement delays.

· Collaborate with Dental, Patient Access, IT, and Revenue Cycle teams to ensure accurate patient registration, insurance verification, and encounter mapping across systems.

· Monitor claim generation workflows between Dental and Medical EMR or software platforms to improve reporting reliability, encounter accuracy, and reimbursement integrity.

· Support data validation and quality assurance initiatives related to Dental billing, encounter reporting, payer submission accuracy, and operational reporting.

· Assist with identifying and escalating system configuration issues, implementation gaps, or workflow inconsistencies impacting Dental reimbursement and reporting accuracy.

Compliance and Documentation

· Ensure accurate and timely submissions for Medicare, Medicaid, WRAP billing, NJ Letters of Agreement (LOA), and City of Trenton grant billing.

· Prepare annual Sliding Fee Scales (SFS) in compliance with HRSA and grant requirements.

· Oversee preparation and submission of Medicare credit balance reports.

· Review patient account adjustments, refunds, and bad debt write-offs in accordance with policy.

· Stay current with changes in healthcare reimbursement, billing rules, and credentialing regulations.

Credentialing & Provider Enrollment

· Assist with monitoring provider enrollment aging and payer participation status to support uninterrupted reimbursement and billing readiness.

· Coordinate provider onboarding workflow activities with Human Resources, Clinical Operations, and departmental leadership to support timely enrollment and credentialing completion.

· Maintain internal tracking related to payer enrollment timelines, participation approvals, and provider reimbursement readiness.

· Assist with resolving payer enrollment delays, credentialing discrepancies, and provider participation issues impacting reimbursement.

· Oversee and manage all aspects of provider credentialing and re-credentialing, including initial applications, renewals, and primary source verifications.

· Ensure compliance with federal, state, payer, HRSA, and NCQA credentialing standards.

· Monitor and track provider license, certification, DEA, insurance, and credential expiration dates to ensure timely renewal and uninterrupted billing.

· Conduct routine audits of credentialing files to maintain accuracy and compliance.

· Serve as liaison between providers, payers, regulatory agencies, and internal departments regarding credentialing and enrollment matters.

· Identify credentialing workflow inefficiencies and implement process improvements.

· Provide training and guidance to credentialing staff on regulatory changes and best practices.

· Prepare and present credentialing status reports to leadership.

ADDITIONAL RESPONSIBILITIES:

· Attend Medical Staff meetings and provide presentations as required.

· Train staff on FQHC billing, coding, and credentialing requirements.

· Assist in onboarding new staff members.

· Manage competing deadlines and a high-volume workload effectively.

· Perform special projects and additional duties as assigned.

· Demonstrate flexibility and willingness to support Finance Department initiatives.

· Duties and responsibilities may evolve based on organizational needs.

REQUIREMENTS:

· Minimum of 4–5 years of experience in an FQHC or similar healthcare setting preferred.

· Minimum of 5–7 years of healthcare billing experience in a primary care setting required.

· Minimum of 3–5 years of experience in provider credentialing or enrollment required.

· At least 3 years of supervisory or leadership experience required.

· Proficiency in Athena EHR system preferred.

LICENSURE AND/OR CERTIFICATIONS:

· Certified Professional Coder (CPC) preferred.

· Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Manager (CPMSM) preferred.

· Organization reserves the right to request certifications and/or licensures as needed.

EDUCATION & EXPERIENCE:

· Bachelor’s degree preferred, or a combination of education and 5–7 years of relevant revenue cycle and credentialing experience.

· Knowledge of medical terminology, CPT and ICD-10 coding principles.

· Strong understanding of Medicare, Medicaid, managed care, and commercial insurance billing.

· Experience with provider enrollment, credentialing, and re-credentialing processes.

· Proficiency in Microsoft Word and Excel.

KNOWLEDGE, SKILLS, ABILITIES AND OTHER (KSAO’s):

· Knowledge: Understanding of healthcare billing practices, compliance regulations, credentialing regulations, and reimbursement methodologies, preferably for FQHC’s. Understanding of the workings

of City, State and Federal assistance programs such as LOA, HRSA, and Grants.

· Skills: Strong analytical skills, attention to detail, and proficiency in Microsoft Office Suite (Excel, Word). Excellent writing skills with the ability to present high level data and information to senior level staff. Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

· Supervisory Skills: Demonstrate exceptional leadership abilities to inspire and motivate our revenue cycle team. Possess proficient performance management capabilities to set clear expectations, provide constructive feedback, and conduct regular evaluations. Strong communication skills are essential. Excel in problem-solving to address complex issues, make data-based decisions, implement process improvements to optimize workflows, resolve conflicts to maintain a collaborative environment, and demonstrate adaptability in navigating changes in healthcare regulations and technology.

· Abilities: Ability to multitask, prioritize workload, follow through on tasks and work independently as well as part of a team. Must be willing to take ownership of work deliverables to ensure assignments/projects are met in a timely fashion. Ability and willingness to meet critical deadlines. Ability to independently set and achieve goals. Demonstrates excellent problem-solving skills, using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.

· Other: Committed to upholding patient confidentiality and delivering exceptional customer service. Skilled in fostering and maintaining effective working relationships with colleagues. Bilingual proficiency preferred. Demonstrates recognition and respect for cultural diversity. Adheres to dress code standards with a neat and clean appearance. Attends annual reviews and departmental in-services as scheduled.

PHYSICAL & WORK REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position requires the manual dexterity sufficient to operate phones, computers and other office equipment. The position requires the physical ability to kneel, bend, and perform light lifting in the amount of 10lbs max. This person must have the ability to write and speak clearly using the English language to convey information and be able to hear at normal speaking levels both in person and over the telephone. Specific vision abilities required by this job include close vision, depth perception and the ability to adjust focus. Generally, the working conditions are good with little or no exposure to extremes in health, safety hazards and/or hazardous materials