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Essen Health Care · 19 hours ago

Credentialing Supervisor

Bronx, NY

Full-time

Onsite

Mid, Senior Level

3+ years exp

Essen Health Care is the largest privately held multispecialty medical group in the Bronx, providing high-quality medical care to vulnerable populations. The Credentialing Supervisor oversees the payor enrollment function, managing the credentialing team and ensuring compliance with regulatory standards.

Health CareMedical

Responsibilities

Comply with Credentialing Policy and Procedures, Departmental Guidelines and Company Policy

Supervise and support the credentialing team in day-to-day operations, providing guidance, training, and performance feedback

Manage offshore credentialing teams, ensuring quality, productivity, and workflow consistency

Ensure compliance with regulatory and payor-specific standards (e.g., NCQA & CMS)

Oversee end-to-end payer enrollment processes, including Medicare (PECOS, I&A), Medicaid, commercial plans, via direct enrollment applications and delegated rosters across multiple states, including NY, TX, OH, PA, MA, NE, and NJ, in compliance with state-specific requirements

Support facility credentialing efforts, including Civil Surgeon designation, Workers’ Compensation, CAQH profile maintenance, hospital affiliations, and accreditation documentation

Track credentialing pipelines, monitor turnaround times, and escalate complex or delayed issues as needed

Conduct payer enrollment gap reviews to identify and resolve lapses or delays in participation

Monitor credentialing pipelines, ensure SLAs are met, and resolve escalated or complex issues

Maintain comprehensive documentation and reporting for audits, regulatory compliance, and leadership updates

Implement process improvements to enhance efficiency, accuracy, and compliance within the credentialing function

Complete other tasks or projects assigned

Provide back-up to other Credentialing staff as necessary

Qualification

Provider credentialingPayer enrollmentRegulatory complianceProcess improvementDatabase managementLeadership skillsAnalytical skillsInformational researchCommunication skillsOrganizational skillsTime managementInterpersonal skills

Required

High School Diploma Required

Bachelor's Degree in a Health-Related Discipline Public Health, Healthcare Administrative, Health Service, Psychology or Sociology Highly Preferred

Minimum of at least 3 years in a medical credentialing / enrollment role. 1 year as supervisor

Proven experience in provider credentialing and payer enrollment, preferably in a supervisory or lead role

Knowledge of CAQH, PECOS, state Medicaid systems, and commercial payer requirements

Strong leadership, organizational, and problem-solving skills

Excellent communication skills, with the ability to collaborate across departments

Detail-oriented, proactive, and able to manage multiple priorities and deadlines

Strong interpersonal and communication skills with an ability to work effectively with a wide range of people, teams, managers, supervisors, and vendors

Proficient with MS Office (outlook, word, excel, power point, access)

Excellent organizational and time-management skills

Excellent verbal and written communication skills

Ability to analyze, interprets and draws inferences from research findings, and prepares reports

Working knowledge of clinical operations and procedures

Informational research skills

Ability to use independent judgment to manage and impart confidential information

Database management skills including querying, reporting, and document generation

Ability to make administrative/procedural decisions and judgments

Preferred

Certified Provider Credentialing Specialist (CPCS), Certified Professional Medical Services Management (CPMSM) or Certified Provider Enrollment Specialist (CPES) a plus

Experience in a multi-specialty medical group or large healthcare organization

Process improvement or workflow optimization experience

Company

Essen Health Care

Glassdoor2.7

Essen Health Care is a premiere healthcare network in New York with over 400 providers across Manhattan, Bronx, Queens, Staten Island, Long Island and Westchester County.

Founded in 1999

Bronx, New York, USA

501-1000 employees