Credentialing & Payor Enrollment Manager

• CAREER OPPORTUNITY OFFERING:

• Bonus Incentives

• Paid Certifications

• Tuition Reimbursement

• Comprehensive Benefits

• Career Advancement

• This pay range for this position is $84,000.00-$105,000.00 annually depending on experience. 

Key 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. 

Knowledge, Skills, and Abilities 

Technical or functional knowledge 

• Provider, group, and facility enrollment lifecycle 

• Commercial, Medicare, Medicaid, and governmental payer requirements 

• Enrollment maintenance, revalidation, termination, ownership change, and demographic update processes 

• Delegated credentialing and payer enrollment operating environments 

• Enrollment documentation, quality controls, audit readiness, and regulatory compliance 

• Revenue cycle dependencies, enrollment-related denials, and reimbursement risk 

Analytical and problem-solving skills 

• 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 

• 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 

• 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 

Required Qualifications 

• 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. 

• This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Desired Qualifications 

• 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.