Credentialing Supervisor

Credentialing Supervisor

The Credentialing Supervisor is responsible for leading all provider credentialing and enrollment functions to ensure timely onboarding, payer participation, and ongoing compliance for clinical providers across the organization. This role oversees the end-to-end provider lifecycle, including provider onboarding, credentialing, payer enrollments, and provider maintenance. The Credentialing Supervisor partners closely with Clinical Operations, Human Resources, Revenue Cycle, Compliance, and external payers to support organizational growth and ensure uninterrupted provider participation with contracted health plans.

Essential Duties and Responsibilities

1. Lead the provider credentialing and enrollment team, establishing priorities, monitoring performance, and fostering professional development.
2. Oversee all provider onboarding activities related to credentialing, payer enrollment, and readiness for clinical practice.
3. Ensure accurate and timely completion of initial credentialing, recredentialing, and payer enrollment processes across all contracted health plans.
4. Manage ongoing provider maintenance activities, including demographic updates, licensure monitoring, CAQH maintenance, payer roster updates, and revalidation requirements.
5. Develop, implement, and continuously improve credentialing workflows, policies, and standard operating procedures to maximize efficiency and compliance.
6. Collaborate with Clinical Operations, Human Resources, Compliance, and Revenue Cycle teams to ensure providers are credentialed and enrolled in alignment with operational needs and organizational timelines.
7. Serve as the primary escalation point for complex credentialing and enrollment issues with payers, delegated credentialing organizations, and regulatory agencies.
8. Monitor credentialing metrics, turnaround times, and key performance indicators to identify opportunities for improvement.
9. Maintain accurate credentialing records and documentation while ensuring data integrity across credentialing systems and payer portals.
10. Support organizational expansion initiatives by coordinating credentialing activities for new locations, new payer contracts, and acquisitions as applicable.
11. Build and maintain positive relationships with payer representatives and external credentialing partners.

Qualifications

• Exceptional organizational skills with a strong attention to detail and commitment to accuracy.
• Demonstrated ability to lead and manage credentialing operations with a high degree of autonomy and accountability.
• Strong prioritization and workload management skills, with the ability to balance competing priorities and deadlines.
• Proven ability to lead multi-state credentialing and recredentialing operations, ensuring providers remain compliant with all payer, licensing, regulatory, and accreditation requirements while meeting critical timelines.
• Advanced computer proficiency, including Microsoft Office Suite and credentialing, payer, or provider database systems.
• Demonstrated experience with credentialing software, data integrity oversight, report generation, and process improvement initiatives.
• Strong verbal and written communication skills, including professional telephone and stakeholder interactions.
• Thorough understanding of confidentiality requirements and the ability to manage sensitive provider, employee, and organizational information with discretion.
• Proven ability to develop, monitor, and improve credentialing processes, policies, and performance metrics to support organizational goals.

Education/Experience Requirements

• Bachelor's degree in healthcare administration, Business Administration, Health Information Management, or a related field preferred.
• Minimum of three (3) years of experience in provider credentialing, recredentialing, and payer enrollment.
• Minimum of two (2) years of leadership or supervisory experience preferred.
• Knowledge of NCQA, CMS, Medicaid, commercial payer, and accreditation-related credentialing requirements.

Physical Requirements

While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time. The team member is occasionally required to stand, walk, and use hands to operate a computer keyboard. The team member may occasionally lift and or move up to 25 pounds. Vision requirements include close vision, distance vision, depth perception and the ability to adjust focus.

Company Overview

Lighthouse Autism Center is the leading Applied Behavior Analysis (ABA) therapy provider in Indiana, Iowa, North Carolina, Nebraska, Michigan, and Illinois and expanding within those states and other states across the U.S. Since 2012, Lighthouse Autism Center has provided the highest quality, center-based ABA therapy to children with autism. At Lighthouse, children work on things like social skills, daily living skills, communication skills, and school-readiness skills. All children are overseen by Board Certified Behavior Analysts and programs are implemented by Registered Behavior Technicians. Lighthouse Autism Center also has full-time Speech-Language Pathologists on staff who provide co-treat and consultative services speech therapy services to children who attend the centers.