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Title
Text copied to clipboard!Provider Enrollment Manager
Description
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We are looking for a Provider Enrollment Manager to lead and manage the provider enrollment process for healthcare professionals and organizations. This role is critical in ensuring that all providers are properly credentialed and enrolled with insurance payers, government programs, and healthcare networks. The Provider Enrollment Manager will oversee a team responsible for the timely and accurate submission of enrollment applications, revalidations, and updates, while ensuring compliance with all regulatory and payer-specific requirements.
The ideal candidate will have a strong background in healthcare administration, provider credentialing, and payer enrollment processes. They should possess excellent organizational and leadership skills, as well as a deep understanding of healthcare regulations, including Medicare, Medicaid, and commercial insurance requirements. The Provider Enrollment Manager will serve as the primary point of contact for internal departments and external stakeholders regarding enrollment status and issues.
Key responsibilities include developing and implementing enrollment policies and procedures, monitoring application progress, resolving enrollment issues, and maintaining accurate provider records. The Provider Enrollment Manager will also be responsible for training and mentoring staff, conducting audits, and ensuring that all enrollment activities align with organizational goals and compliance standards.
This position requires strong communication skills, attention to detail, and the ability to manage multiple priorities in a fast-paced environment. The Provider Enrollment Manager will play a vital role in supporting the organization’s revenue cycle and ensuring that providers are able to deliver care without administrative delays.
Responsibilities
Text copied to clipboard!- Manage the end-to-end provider enrollment process
- Ensure compliance with federal, state, and payer-specific regulations
- Oversee submission of enrollment applications and revalidations
- Develop and maintain enrollment policies and procedures
- Monitor and track application status and resolve issues
- Collaborate with credentialing, billing, and compliance teams
- Train and supervise enrollment staff
- Maintain accurate and up-to-date provider records
- Conduct internal audits to ensure data integrity
- Serve as liaison with payers and regulatory agencies
- Implement process improvements to enhance efficiency
- Prepare reports and metrics for leadership
Requirements
Text copied to clipboard!- Bachelor’s degree in healthcare administration or related field
- 5+ years of experience in provider enrollment or credentialing
- Strong knowledge of Medicare, Medicaid, and commercial payer requirements
- Experience managing a team in a healthcare setting
- Excellent organizational and time management skills
- Proficiency in enrollment and credentialing software systems
- Strong communication and interpersonal skills
- Detail-oriented with a focus on accuracy
- Ability to handle confidential information with discretion
- Knowledge of healthcare compliance and regulatory standards
- Problem-solving and analytical skills
- Ability to work independently and collaboratively
Potential interview questions
Text copied to clipboard!- How many years of experience do you have in provider enrollment?
- Have you managed a team in a healthcare setting before?
- What enrollment software systems are you familiar with?
- Can you describe your experience with Medicare and Medicaid enrollment?
- How do you ensure compliance with payer requirements?
- Describe a time you resolved a complex enrollment issue.
- What strategies do you use to manage multiple priorities?
- How do you stay updated on changes in healthcare regulations?
- What metrics do you use to track enrollment performance?
- Have you conducted internal audits of enrollment data?
- How do you train and support new enrollment staff?
- What process improvements have you implemented in past roles?