Manager, Provider Enrollment & Managed Care Ops. Financial Admin, Full Time, Day
About The Position
The Manager, Provider Enrollment and Managed Care Operations is responsible for the operational management, oversight and performance of Valley Health System's payer relations, provider enrollment and delegated credentialing functions. The position translates the organization's managed care strategy and contractual requirements into operational processes, establishes performance standards and ensures that payer, provider enrollment and delegated credentialing activities are executed accurately, timely and in compliance with applicable payer and regulatory requirements. This position provides direct leadership and oversight to the provider enrollment team, ensuring timely and accurate enrollment of providers with payers, maintenance of enrollment records, and resolution of enrollment-related issues. Position serves as internal owner of delegated credentialing matters and ensures that Valley remains compliant with all delegated credentialing requirements. This position also serves as a one of the key subject matter experts for the system for any education related to insurance industry changes, managed care regulation, and impactful payer policies/protocol changes. The position serves as an internal resource and external liaison for managed care matters, coordinating input from Revenue Cycle, Payer Analytics, Legal, Finance, and clinical leadership to implement and operationalize payer strategies, policies or protocols and escalate health system payer issues.
Requirements
- Bachelor's Degree required.
- A minimum of five years' experience in managed care in a health care setting (medical office/hospital/insurance) required.
- Knowledge of the healthcare industry and payor reimbursement methodologies.
- A minimum of three years’ experience in payer enrollment with experience with delegated credentialing strongly preferred.
- Leadership and team management
- Managed care and payer operations expertise
- Provider enrollment and delegated credentialing knowledge
- Healthcare reimbursement and payer relations experience
- Strategic planning and operational oversight
- Process improvement and workflow optimization
- Analytical and problem-solving skills
- Contract interpretation and regulatory compliance
- Cross-functional collaboration and stakeholder management
- Strong written, verbal, and presentation skills
- Performance measurement and data analysis
- Change management and organizational influence
- Relationship management and customer service excellence
Nice To Haves
- Experience with delegated credentialing strongly preferred.
Responsibilities
- Operational management, oversight and performance of payer relations, provider enrollment and delegated credentialing functions.
- Translating managed care strategy and contractual requirements into operational processes.
- Establishing performance standards for payer, provider enrollment and delegated credentialing activities.
- Ensuring accurate, timely, and compliant execution of payer, provider enrollment and delegated credentialing activities.
- Providing direct leadership and oversight to the provider enrollment team.
- Ensuring timely and accurate enrollment of providers with payers.
- Maintaining enrollment records.
- Resolving enrollment-related issues.
- Serving as internal owner of delegated credentialing matters and ensuring compliance with requirements.
- Serving as a key subject matter expert for insurance industry changes, managed care regulation, and payer policy/protocol changes.
- Serving as an internal resource and external liaison for managed care matters.
- Coordinating input from various departments (Revenue Cycle, Payer Analytics, Legal, Finance, clinical leadership) to implement and operationalize payer strategies, policies or protocols.
- Escalating health system payer issues.
Benefits
- Medical/Prescription, Dental & Vision Discount Program (Full Time/Part Time Employees)
- Group Term Life Insurance and AD&D(Full Time Employees)
- Flexible Spending Accounts and Commuter Benefit Plans
- Supplemental Voluntary Benefits ( e.g. Short-term and Long-term Disability, Whole Life Insurance, Legal Support, etc.)
- 6 Paid Holidays, Paid Time Off (varies), Wellness Time Off, Extended Illness
- Retirement Plan
- Tuition Assistance
- Employee Assistance Program (EAP)
- Valley Health LifeStyles Fitness Center Membership Discount
- Day Care Discounts for Various Daycare Facilities
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What This Job Offers
Job Type
Full-time
Career Level
Manager
