Provider Enrollment Manager

The Provider Enrollment Manager is responsible for leading and overseeing all aspects of the provider enrollment process. This role ensures timely and compliant onboarding of healthcare providers by managing operational workflows, ensuring regulatory adherence, and fostering effective collaboration with internal and external stakeholders. The ideal candidate brings strong leadership experience, deep knowledge of enrollment requirements, and a commitment to accuracy and service excellence.  The Provider Enrollment Manager plays a vital role in our Payor Strategy Team.  The successful candidate will report to Director, Enrollment.

Key Responsibilities

Team Leadership & Oversight

• Lead, mentor, and develop the provider enrollment team, promoting high performance, accountability, and continuous improvement.

• Design and implement training programs to ensure staff proficiency in enrollment policies, credentialing systems, tracking checklists, turnaround times and compliance requirements.

Enrollment Operations

• Manage the full lifecycle of provider enrollment, including initial applications, recredentialing, terminations, entity ownership changes are submitted to plans timely for all providers.

• Optimize operational workflows to enhance efficiency, reduce turnaround times, and improve the overall provider onboarding experience.

• Organize and lead the weekly Provider Enrollment Team meeting(s).

Compliance & Quality Assurance

• Ensure adherence to federal, state, and payer-specific regulations, including CMS and NCQA standards.

• Conduct regular audits of enrollment files and processes to ensure data accuracy, completeness, and compliance.

Stakeholder Collaboration

• Serve as the main liaison between providers, payers, credentialing teams, and internal departments to facilitate smooth enrollment processes.
• Investigate and resolve escalated issues related to application delays, denials, or discrepancies in provider data.
• Responds to requests from management, staff, providers, outside entities, field operators and field representatives related to enrollment of practitioners.

Technology & Reporting

• Utilize provider enrollment systems and databases (e.g., CAQH, PECOS, NPPES) to maintain accurate records and monitor application statuses.

• Generate and analyze key performance metrics, presenting actionable insights to senior leadership for strategic decision-making.

• Ensures facility and practitioner directory data is accurate and in good standing with plan partners.

• Ensures that all processing and reporting deadlines are consistently achieved.

Qualifications

• Bachelor’s degree (or equivalent experience) required.

• PESC, CPCS, or CPMSM certified preferred.

• 5+ years of management or supervisory experience in provider enrollment, credentialing in a health care setting with at least 3 years’ experience in a medium to large health system.

• Strong understanding of CMS, NCQA, and payer-specific enrollment requirements.

• Proficient with provider enrollment platforms (e.g., CAQH, PECOS, NPPES) and credentialing databases.

• Proficient in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint).

Preferred Skills

• Experience with electronic health record (EHR) systems and provider data management tools.

• Excellent organizational skills with the ability to manage multiple priorities in a fast-paced environment.

• Detail-oriented, with a strong focus on accuracy and maintaining confidentiality.

• Exceptional verbal and written communication skills.

• Strong analytical thinking and problem-solving abilities.

• Excellent time management, prioritization and organizational skills.

• Ability to work independently and proactively in a fast-paces, dynamic environment.

• Self-motivated, directed and proactive.

• Demonstrates ability to lead, manage, motivate teams and communicate effectively.

Salary: $82,000 - 95,000, plus bonus incentives

• A generous benefits package that includes paid time off, health, dental, vision, and 401(k) savings plan with match