Credentialing & Payor Enrollment Manager

Ensemble Health Partners•Work at Home - Ohio - Other, OH

20h•$84,000 - $105,000•Hybrid

About The Position

The Manager, Provider Enrollment provides operational and people leadership for provider enrollment activities across a defined organizational scope. The role establishes performance expectations, monitors key performance indicators, oversees quality and compliance controls, resolves complex enrollment issues, and drives process improvement. The position ensures enrollment activities support timely payer participation, accurate reimbursement, organizational readiness, and scalable operations. The role partners with revenue cycle, credentialing, billing, compliance, technology, and operational stakeholders to coordinate payer enrollment requirements and resolve risks affecting enrollment status or reimbursement. The position leads supervisors and staff, manages escalations, standardizes workflows, supports system and reporting improvements, and translates performance information into clear operational and leadership insights.

Requirements

Bachelor’s degree in healthcare administration, business administration, operations, or a related field, or an equivalent combination of education and relevant experience.
Seven or more years of provider enrollment experience, including experience with Medicare, Medicaid, and commercial payers.
Three or more years of formal people leadership experience.
Experience overseeing provider enrollment compliance, quality assurance, audit readiness, and payer requirements.
Experience working cross-functionally with revenue cycle, billing, credentialing, compliance, technology, or related operational teams.
Demonstrated analytical, organizational, communication, and problem-solving capability.
Technical or functional knowledge of the provider, group, and facility enrollment lifecycle.
Knowledge of commercial, Medicare, Medicaid, and governmental payer requirements.
Understanding of enrollment maintenance, revalidation, termination, ownership change, and demographic update processes.
Familiarity with delegated credentialing and payer enrollment operating environments.
Knowledge of enrollment documentation, quality controls, audit readiness, and regulatory compliance.
Understanding of revenue cycle dependencies, enrollment-related denials, and reimbursement risk.
Analytical and problem-solving skills including KPI design and operational performance analysis, backlog, aging, productivity, capacity, and quality analysis, root cause analysis and corrective action planning, risk identification, escalation, and mitigation, process mapping, workflow standardization, and continuous improvement, data quality and reporting interpretation.
Leadership and communication skills including people leadership, coaching, and performance management, workforce planning, prioritization, and accountability, cross-functional stakeholder coordination, clear written, verbal, and executive-level communication, conflict resolution and complex issue escalation, change leadership and adoption support.
Systems and operational skills including provider enrollment and credentialing technology platforms, reporting, workflow, document management, and productivity tools, system implementation and enhancement support, data governance and audit-ready documentation, standard operating procedures, job aids, and training controls.
Candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Nice To Haves

Experience supporting multi-state Medicaid enrollment operations.
Experience in a delegated credentialing environment.
Experience with enterprise provider enrollment or credentialing platforms.
Experience leading supervisors or other people leaders.
Experience supporting system implementations, workflow redesign, data governance, or operational reporting improvements.
Demonstrated advanced usage of AI and the management of teams using AI to lean into process and technological improvements, to include the exploration, experimentation, and application of AI.

Responsibilities

Lead end-to-end provider enrollment operations for providers, groups, and facilities across commercial and governmental payers.
Translate organizational priorities into enrollment operating plans, service standards, performance expectations, and measurable outcomes.
Establish, monitor, and refine key performance indicators for timeliness, quality, productivity, backlog, compliance, and revenue protection.
Lead, coach, and develop provider enrollment supervisors and staff; manage performance, capacity, accountability, and succession planning.
Oversee new enrollments, revalidations, terminations, demographic and ownership changes, maintenance activities, and large-scale organizational updates.
Monitor application aging, backlog, payer turnaround, and escalation trends; direct action on high-risk or revenue-impacting issues.
Ensure enrollment activities are documented accurately and maintained in approved systems and records.
Maintain compliance with payer, regulatory, and accreditation requirements and oversee quality assurance, audits, and corrective actions.
Partner with revenue cycle, billing, and accounts receivable teams to identify and resolve enrollment-related denials, delays, and financial exposure.
Drive process standardization, workflow improvement, data integrity, and operational scalability.
Partner with technology and operations teams on system implementation, enhancement, reporting, and data-governance needs.
Prepare and present performance insights, risks, capacity considerations, and improvement opportunities to leadership and stakeholders.