Key Responsibilities:
Leadership & Team Management:
Lead, mentor, and manage Team Leads, SMEs, and Provider Enrollment Associates
Conduct regular 1:1s, performance reviews, coaching sessions, and development planning
Support hiring, onboarding, and training to build a scalable and high-performing enrollment organization
Foster a culture of accountability, ownership, collaboration, and continuous improvement
Provider Enrollment Operations:
Oversee end-to-end provider enrollment and revalidation workflows across Medicare, Medicaid, and commercial payers
Ensure accurate preparation, submission, and tracking of enrollment applications
Act as an escalation point for complex enrollment issues, payer rejections, delays, and discrepancies
Ensure compliance with federal, state, and payer-specific enrollment requirements
Operational Excellence & Compliance:
Monitor SLAs, turnaround times, quality metrics, and productivity across teams
Review enrollment files and workflows to ensure consistency, accuracy, and timeliness
Maintain strong working knowledge of payer-specific rules, documentation standards, and timelines
Process Improvement & Scalability:
Analyze enrollment pipelines, volumes, and trends to forecast staffing and capacity requirements
Identify operational gaps and implement SOPs, controls, and process improvements
Partner with internal stakeholders to introduce new payer types, workflows, or service offerings
Leverage enrollment platforms and tools (e.g., CAQH, NPPES, payer portals) to drive efficiency
Stakeholder & Client Engagement:
Serve as a senior escalation point for client and provider concerns
Communicate enrollment status, risks, and resolutions clearly to leadership and clients
Prepare and present operational updates, metrics, and insights
Collaborate cross-functionally with Credentialing, Licensing and Product teams
Strategic Responsibilities (Senior Manager Scope):
Contribute to enrollment strategy, capacity planning, and long-term operational scalability
Support leadership initiatives related to growth, regulatory changes, or market expansion
Ensure alignment between day-to-day execution and organizational objectives
Qualifications & Experience:
Bachelor’s degree in healthcare administration, business, or a related field (preferred)
Mandatory strong, hands-on experience in Provider / Payer Enrollment
Manager Level
6–8+ years of experience in Provider Enrollment
3+ years of people management experience in a high-volume environment
Senior Manager Level
10–12+ years of experience in Provider Enrollment
6–8+ years of experience managing managers, team leads, or large operational teams
