HPS Supervisor, Credentialing

Job description

Department Overview Responsible for the end-to-end credentialing and recredentialing processes for all network-affiliated providers, ensuring compliance with regulatory, accreditation, and delegated contract requirements (e.g., NCQA, CMS, OHA). Ensures accurate and timely submission of applications, completion of primary source verifications, and entry of provider data. Maintains credentialing information in MSOW and/or Credential Stream and monitors license, certification, and insurance expirations. Leads and supports delegated credentialing audits, including document collection, audit preparation, and response coordination. Exercises independent judgment within defined policies and contributes to ongoing process improvement initiatives. In addition to core credentialing responsibilities, the Credentialing Supervisor collaborates closely with the Health Plan Services leadership team to ensure credentialing operations support audit readiness, regulatory compliance, and the integrity of the provider network. Function/Duties of Position: - Coordinate and maintain provider credentialing files, documentation, and application tracking - Review credentialing and recredentialing submissio...