Full-Time Manager Provider Enrollment

Manager of Enrollment oversees the enrollment program and acts as primary liaison for clinics, payers, billing office, and practitioners.

Ensures all healthcare providers are accurately enrolled with various health plans (federal, state, marketplace, commercial).

Strong knowledge of operational processes, credentialing, and payer enrollment is required, focusing on efficiency and smooth provider onboarding.

Key Responsibilities:

• Lead all enrollment activities to ensure provider participation status
• Lead all demographic updates to ensure provider termination
• Follow protocols for timely resolution, payor enrollment, and no revenue loss due to untimely enrollment.
• Ensure compliance with health plan requirements for provider certification and credentialing.
• Work with internal and external stakeholders to resolve provider enrollment issues, including claim denials.
• Collaborate with RCM leadership to identify enrollment issues affecting claims payment and develop action plans.
• Manage special projects requiring understanding of payer enrollment and its impact on claims processing.
• Interact effectively with varied levels of management, physician office staff, and physicians for enrollment before new Care Center or Provider implementation
• Maintain updated provider data in credentialing databases, internal systems, and Athena
• Mentor and train new and existing staff
• Lead meetings with key internal and external stakeholders autonomously
• Assist in managing information flow between payers, contracted MSO facilities, and PMG
• Coordinate and prepare reports
• Record and track enrollment statistics
• Other duties as assigned

Experience Requirements:

• 5+ years experience in managed care enrollment, billing, or Medical Staff service settings
• Experience with Texas Medicaid enrollment
• Proficient in Excel
• Demonstrated problem-solving, analysis, and resolution skills
• 5+ years of people management experience (preferred)
• Intermediate/advanced Microsoft Excel skills (required)
• Experience using Verity CredentialStream (preferred)
• Athena EMR experience (required)
• Experience supporting Medicare/Medicaid (preferred)
• CAQH experience (preferred)
• Ability to function independently and demonstrate flexibility in multiple project management
• Must comply with HIPAA rules and regulations

Salary: $68,000.00 to $75,000.00 base pay (exclusive of bonuses and benefits). Eligible for annual bonus (15%) and restricted stock units.

Technical Requirements (Remote Workers):

• Minimum Download Speed: 5 Mbps
• Minimum Upload Speed: 3 Mbps

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