Credentialing supervisors work primarily in hospitals within an office with a computer and handwritten logs. These supervisors coordinate all credentialing activities to improve participation status, such as communicating with outside agencies to comply with necessary requisites.
Credentialing supervisors must keep logs, lists, records, and documentation needed for credentialing and re-credentialing and maintain a complete database of claims for financial impact reporting and workforce management. It is important that they stay up-to-date with health care providers' plans and networks to ensure that all claims and coordinated efforts adhere to regulations and requirements. They work closely with the payer relations department to resolve contract reimbursement issues and must keep logs of contract requirements and justify reimbursements when necessary. They also prepare and facilitate materials for committee meetings and should have strong social skills to lead a department, and some may be required to train team members in claims processing, billing, provider relations, and contracting with outside agencies.
A bachelor's degree and prior experience in the billing/claims field are generally required for this position, and credentialing supervisors typically work full-time during regular business hours. Some overtime may be provided to ensure that reports and materials needed for meetings are completed and databases are kept up-to-date.
Credentialing Supervisor Tasks
Assist in hiring, training and reviewing performance of staff.
Ensure services are in compliance with professional standards, bylaws, state and federal regulatory requirements.
Supervise staff and give administrative direction.
Maintain departmental day-to-day credentialing activities, monitor and prioritize workflow and schedules.
Ensure adherence to departmental policies and procedures.