Manager, Provider Enrollment

The Manager of Enrollment oversees the enrollment program and is the primary liaison for clinics, payers, the billing office, and practitioners. This role ensures that all healthcare providers are accurately enrolled with various health plans, including federal, state, marketplace, and commercial options. The ideal candidate should have strong knowledge of operational processes, credentialing, and payer enrollment, focusing on enhancing efficiency and ensuring smooth provider onboarding and enrollment operations. Lead all enrollment activities to ensure provider participation status Lead all demographic updates to ensure provider termination; demographic updates are submitted to payers and processed Ensure protocols are followed to ensure timely resolution, completion of payor enrollment, and no revenue loss due to untimely enrollment. Assures compliance with all health plan requirements related to the provider certification and credentialing. Works with both internal and external stakeholders to provide regular updates and resolve complex provider enrollment status and/ or issues, including resolving claim denials related to provider enrollment Collaborates with RCM leadership to identify enrollment issues affecting claims payments and develop an action plan to resolve them. Manages special projects that require understanding payer enrollment and its effects on claims processing. Interacts with varied levels of management, physician office staff, and physicians effectively to accomplish enrollment before implementation of new Care Center or Provider Maintain up-to-date data for each provider in credentialing databases, internal tracking systems, and Athena to ensure timely release of claims and notification to Care Center and providers of their enrollment status Mentor and train new and existing staff. Autonomously lead meetings with key internal and external stakeholders. Assist in managing the flow of information between the payers, contracted MSO facilities, and PMG. Coordinate and prepare reports Record and track enrollment statistics Other duties as assigned.