Manager, Provider Enrollment

MDVIP • Boca Raton, FL

5d

About The Position

MDVIP is seeking a Provider Enrollment Manager to lead insurance provider enrollment for its affiliated physicians. Reporting to the Associate Director of Insurance & Credentialing, this role oversees enrollment, credentialing, and contracting operations and provides expert guidance to physicians, practice staff, internal stakeholders, payers, clearinghouses, and regulatory bodies. The manager handles complex and escalated enrollment matters, ensures compliance with licensing and credentialing requirements, and contributes insights that may inform network participation strategy and operational performance.

The role leads the Provider Enrollment team, including workflow oversight, coaching, performance management, training, and accountability. It is responsible for enrollment data integrity, accurate and timely processing, performance reporting, risk identification, and continuous improvement. The manager also evaluates payer participation strategies and physician-specific needs, coordinates with Leadership and Legal on contractual risks, and delivers analysis and executive-level reporting to support decisions and operational planning.

The position requires demonstrated leadership in provider enrollment or credentialing, analytical and communication skills, and the ability to work effectively in a complex, matrixed, regulated environment. An associate’s degree and related experience are listed among the minimum qualifications, along with familiarity with EMR and credentialing software and proficiency in Microsoft Office. Preferred qualifications include experience with specified enrollment and credentialing platforms and relevant professional certifications.

Requirements

• Associate’s degree and related business experience; the posting states “at least two (4) years related business experience.”
• Five years of related work experience.
• Demonstrated leadership experience managing provider enrollment or credentialing functions in a complex, matrixed environment.
• Strong analytical and critical-thinking skills, including interpreting complex data and translating findings into business insights.
• Ability to build effective relationships with physicians, staff, payers, and cross-functional stakeholders.
• Clear, professional communication skills and ability to influence diverse audiences.
• Proactive, solutions-oriented leadership that drives accountability, continuous improvement, and operational excellence.
• Strong organization and execution, with consistent focus on deadlines, accuracy, and outcomes.
• Strategic thinking, including assessing risk, identifying trends, and informing leadership-level decision-making.
• Familiarity with EMR and credentialing software.
• Proficiency in Microsoft Office applications.

Nice To Haves

• Experience with CAQH, PECOS, and NPPES applications.
• Experience with Net Docs, credentialing software, and athena.
• Certified Provider Credentialing Specialist (CPCS).
• Certified Provider Enrollment Specialist (CPES).
• Experience with Salesforce or other CRM tools.

Responsibilities

• Lead, coach, and manage the performance and development of the Provider Enrollment team.
• Oversee team workflows, priorities, and productivity to ensure enrollment, credentialing, and contracting requirements are completed accurately and on time.
• Manage complex and non-standard enrollment and contracting scenarios, including exceptions, escalations, payer-specific requirements, and high-priority cases.
• Oversee end-to-end provider enrollment operations, ensuring compliance, data accuracy, and quality service delivery.
• Serve as a subject matter expert and liaison among physicians, internal stakeholders, payers, clearinghouses, regulatory bodies, and external partners.
• Govern provider enrollment data, ensuring integrity and reconciliation and identifying risks that could affect revenue, access, or compliance.
• Monitor program performance through reporting and analytics, identify trends, and drive continuous improvement.
• Evaluate payer participation strategies and physician-specific needs, advising on best practices, payer mix, timelines, and revenue implications.
• Partner with Leadership and Legal to identify and mitigate contractual risks or conflicts.
• Manage credentialing and contracting timelines and renewals proactively.
• Develop and deliver onboarding, training, and ongoing skills development for team members and stakeholders.
• Research and resolve complex enrollment and credentialing issues with federal and commercial payers.
• Complete statewide credentialing applications to establish new groups and add providers to commercial payers and Medicare.
• Analyze and reconcile provider enrollment information across systems, identifying discrepancies, downstream risks, and potential red flags.
• Provide affiliates, physician staff, and billing companies with training and guidance on preventive billing protocols and provider enrollment needs when requested.
• Represent the Provider Enrollment team during virtual and onsite corporate visits, explaining workflows, historical and regional performance metrics, and practice-specific considerations to support physician onboarding.
• Oversee development, analysis, and distribution of provider enrollment status reports, ensuring accuracy, timeliness, follow-up, and case closure.
• Translate enrollment and contracting data into actionable insights and deliver reports and presentations for leadership decision-making and operational planning.
• Analyze and reconcile enrollment data across complex workflows to ensure accuracy, compliance, and alignment with contracting requirements.
• Resolve escalated and high-risk enrollment and contracting issues through root-cause analysis, recommendations, and executive-level visibility when needed.
• Maintain subject matter expertise through ongoing education and awareness of industry trends.

Benefits

• Medical and prescription drug coverage
• Dental coverage
• Vision coverage
• Flexible Spending Account
• Health Savings Account
• Dependent Care Flexible Spending Account
• Basic and supplemental life insurance
• Accidental Death and Dismemberment coverage
• Disability Income Protection Plan
• Employee Assistance Program
• 401(k) retirement program
• Vacation
• Paid holidays
• Personal time
• Paid sick leave
• Paid family and medical leave as required by law
• Annual incentive compensation programs, subject to eligibility and other applicable factors
• Ongoing training and leadership development programs

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree