Supervisor, Provider Relations & Credentialing

Job Description

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's Degree in Healthcare Administration, Business Administration, or a related field.

EXPERIENCE:

1. Two (2) years of healthcare credentialing, provider relations, or medical staff services experience to include Direct Supervisory or Lead Experience

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Master's Degree in a relevant field (Healthcare Administration, Public Health, Business Administration).

2. Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Lead, supervise, and perform performance evaluations for staff to ensure performance expectations are met and professional development is supported.
2. Oversee the end-to-end credentialing process, including licensure applications, privileging documentation, DEA registrations, and payer enrollment coordination.

3. Manage provider relations by serving as a key point of contact for new and existing providers during onboarding and credentialing processes.
4. Monitor workflow and team performance, ensuring timely credentialing and recredentialing to meet hiring and compliance deadlines.
5. Collaborate closely with department leadership, Medical Staff Affairs, provider enrollment teams, and external agencies to facilitate a seamless onboarding and credentialing experience.

6. Manage escalations and resolve complex credentialing and provider onboarding issues.
7. Maintain updated knowledge of credentialing standards, healthcare regulations, and best practices, ensuring team compliance and continuous improvement.
8. Facilitate the preparation of provider packets, reappointment processes, and maintain up-to-date credentialing databases and profiles.
9. Oversee tracking and reporting of provider state licenses, board certifications, and Continuing Medical Education (CME) requirements.
10. Provide regular reporting on credentialing, onboarding, and provider engagement metrics to department leadership and other stakeholders.

11. Develop and implement standard operating procedures (SOPs) and credentialing workflows.
12. Ensure proper maintenance and security of provider credentialing records and documentation.
13. Lead departmental projects related to credentialing improvements, onboarding enhancements, and provider satisfaction initiatives.

PHYSICAL 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.

1. Office work which includes sitting for extended periods of time.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office work which includes sitting for extended periods of time.

SKILLS AND ABILITIES:

1. Strong oral and written communication skills.

2. Strong analytics and attention to detail.

3. Ability to problem solve and prioritize multiple projects.

4. Ability to work with provider and administrative leadership across the system.

5. Strong Computer skills to include Word, Excel, PowerPoint - EPIC preferred.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center:

Address:

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.