Provider Enrollment Manager
About The Position
This Enrollment Manager serves as an operational leader and subject matter expert in revenue cycle management and accounts receivable operations. Key responsibilities of the role include building an outstanding team culture through consistent engagement; fostering professional development of all direct and indirect reports, especially the next generation of CHOP leaders; identifying, deploying, and maintaining best practices in revenue cycle operations; understanding and monitoring Key Performance Indicators (KPIs), and taking quick and appropriate action to maintain the financial health of CHOPPA. The Provider Enrollment Manager is responsible for overseeing the day-to-day operations of provider enrollment activities, ensuring timely and accurate enrollment, revalidation, and maintenance of provider records across all payers. This role leads a team of enrollment professionals, drives operational efficiency, and supports revenue cycle performance through effective enrollment processes. The Manager partners cross-functionally with internal stakeholders, including clinical and revenue cycle teams, and serves as a key escalation point for complex enrollment issues. This role also supports workflow optimization within Credentialing systems (e.g. CredentialStream) and leverages reporting insights to improve performance, while maintaining a strong focus on team leadership, process consistency, and service excellence.
Requirements
- High School Diploma / GED Required
- At least five (5) years experience in provider enrollment and/or credentialing with large healthcare organizations, Medicare and Medicaid Required
- At least three (3) years leadership or supervisory or leadership role within a healthcare environment Required
- Strong knowledge of: CMS (Medicare/Medicaid) enrollment processes; Commercial payer enrollment requirements; CAQH, PECOS, NPPES, and payer portals (e.g., Availity) (Required proficiency)
- Understanding of revenue cycle workflows and financial impact of enrollment delays (Required proficiency)
- Excellent leadership, coaching, and team development skills (Required proficiency)
- Strong analytical and problem-solving abilities (Required proficiency)
- Advanced organizational and time management skills (Required proficiency)
- High attention to detail and commitment to data accuracy (Required proficiency)
- Strong communication and interpersonal skills, with ability to work cross functionally (Required proficiency)
- Knowledge of HIPAA and data privacy requirements (Required proficiency)
Nice To Haves
- Bachelor's Degree Preferred
Responsibilities
- Lead, coach, and develop a team of Provider Enrollment Coordinators and/or Specialists
- Recruit, train, mentor, and evaluate staff to ensure high performance and professional development.
- Establish clear performance expectations, productivity standards, and accountability measures.
- Conduct regular team meetings, one-on-ones, and performance evaluations.
- Support onboarding and training of new team members
- Foster a culture of accuracy, urgency, collaboration, and continuous improvement.
- Oversee the full lifecycle of provider enrollment, including: initial enrollment, revalidation and recredentialing, updates, and terminations.
- Ensure timely submission, tracking, and follow-up of all enrollment applications.
- Monitor work queues and ensure appropriate prioritization of tasks
- Identify inefficiencies in enrollment workflows and implement process improvements
- Standardize procedures to ensure consistency across the team
- Partner with leadership on larger process improvement initiatives
- Support system enhancements and workflow optimization efforts
- Ensure provider enrollment activities comply with all applicable federal, state, and payer-specific requirements
- Maintain current knowledge of payer enrollment rules, regulatory updates, and industry best practices.
- Partner with Compliance and Credentialing teams to support audit readiness and regulatory inquiries
- Ensure accuracy and integrity of provider enrollment data across systems
- Monitor and address compliance-related risks within enrollment workflows
- Track and monitor key performance indicators such as enrollment turnaround times and application aging
- Provide regular reporting and insights to leadership
- Identify trends and implement corrective actions to improve performance.
- Serve as the primary escalation point for complex enrollment issues and payer-related challenges
- Partner with internal stakeholders to resolve delays, denials, and discrepancies
- Maintain strong relationships with payer representatives to facilitate issue resolution.
- Collaborate with Credentialing, Medical Staff Services, Billing, and Operations teams
- Support provider onboarding and readiness for billing
- Participate in organizational initiatives related to enrollment and revenue cycle operations
Benefits
- Annual influenza vaccine
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
High school or GED
