HPS Supervisor, Credentialing

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.

• Coordinate and maintain provider credentialing files, documentation, and application tracking 
• Review credentialing and recredentialing submissions; perform primary source verifications 
• Maintain credentialing system(s); ensure timely updates to licensure, DEA, insurance, and directory fields 
• Perform delegated credentialing audits, prepare materials, respond to findings, and track remediation 
• Monitor regulatory standards; support updates to policy, workflows, and audit tools
• Other duties as assigned

• High School Diploma or GED AND 3 years of credentialing experience in a healthcare or insurance provider setting. OR
• Associate’s degree in a related field and three (3) years of experience in data collection or analysis using credentialing software; OR
• equivalent combination of education and experience.
• Minimum one (1) year experience supporting delegated credentialing audits.
• Familiarity with NCQA standards and CMS/OHA credentialing requirements.
• Experience using credential software (e.g., MSOW, CredentialStream).

Job Related Knowledge, Skills and Abilities (Competencies)

• Proficiency with credentialing systems and Microsoft Office Suite (Word, Excel, Outlook).
• Ability to manage multiple priorities and meet deadlines. 
• Knowledge of NCQA, CMS, and Oregon Health Authority credentialing standards. 
• High attention to detail and accuracy in data entry and documentation. 
• Strong verbal and written communication skills. 
• Ability to interpret complex regulatory guidelines and apply them to credentialing processes.

• Five (5) years of credentialing experience in a healthcare or managed care setting.
• Experience with provider directories, managed care plans, and audit preparation.
• Certified Provider Credentialing Specialist (CPCS) preferred

This position is primarily remote, with occasional in-person meetings or onsite work as required by departmental needs. Standard working hours apply, with flexibility based on project timelines or operational priorities. The role is not routinely exposed to environmental hazards; however, all employees must follow OHSU’s safety policies related to remote and onsite work environments.

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