Manager, Payer Enrollment - Managed Care

The Manager, Payer Enrollment oversees the end-to-end payer enrollment and provider credentialing functions for the organization. This role manages a team responsible for application preparation, submission, follow-up, and maintenance of provider demographics and credentials across commercial, governmental, and network payers. The manager leads people management activities, including recruitment, hiring, onboarding, training, retention, performance management, and career development. The position also serves as project lead for acquisitions and practice/facility onboarding, coordinating payer enrollment activities to meet go-live timelines.

Ensures operations align with organizational policy, standards of practice, and federal/state regulations.

• Lead and manage the payer enrollment and credentialing team: oversee daily operations, workload balancing, and service-level adherence
• Own people management lifecycle: recruit, interview, hire, onboard, train, coach, set goals, conduct performance evaluations, and implement performance improvement plans
• Establish and maintain standard operating procedures (SOPs), workflows, and quality controls; define and report performance metrics (e.g., cycle time, first-pass yield)
• Plan and lead payer enrollment work streams for acquisitions, new practices, and new facilities; develop project plans, milestones, risk logs, and status reporting to leadership
• Ensure timely and accurate submission of payer enrollment applications, revalidations, delegated contracts requirements and annual audits, demographic updates, and renewals (Medicare/Medicaid and commercial payers)
• Maintain provider data integrity across credentialing databases and online systems; oversee CAQH profiles, license/certification expirations, DEA and malpractice documentation
• Serve as primary liaison between practitioners, payers, and internal stakeholders; identify delays, escalate issues, and drive resolution
• Collaborate with revenue cycle, managed care, compliance, medical staff services, and IT to proactively address credentialing impacts on billing and claims adjudication
• Develop and deliver role-based training; assess skills gaps and implement cross-training to ensure coverage and business continuity
• Monitor and ensure compliance with federal and state regulations, accreditation standards, payer requirements, and organizational policies
• Continuously review processes to identify improvements; lead small-to-medium process/project initiatives to enhance accuracy, speed, and stakeholder experience
• Prepare and present reports and dashboards to leadership; communicate project goals, risks, and decisions using clear, timely updates

Education Requirements

• Required:
  
  Associate's Degree in Healthcare Administration, Business Administration, or related field; four (4) years of equivalent work experience may be considered in lieu of an Associate's Degree
• Preferred:
  Bachelor's Degree in Healthcare Administration, Business Administration, or related field

License or Certification Requirements

• Preferred:
  Certification
  • Certified Provider Credentialing Specialist (CPCS) from the National Association of Medical Staff Services

Experience Requirements

• Required:
  
  2 years of experience with an Associate's Degree, at least two years of revenue cycle, healthcare, or other financial/business management experience is required. An advanced degree may be considered in lieu of experience

Knowledge:

• Microsoft Office applications; credentialing/enrollment databases and portals (e.g., CAQH)
• Delegated credentialing, committee, and audit processes
• Registration procedures, insurance coverage, billing requirements, payer policies
• Familiarity with medical billing and coding practices
• Familiarity with healthcare regulations and payer processes
• Strong knowledge of Microsoft Office applications

Skills:

• Analytical
  
  Skills:
  
  The ability to analyze large data sets, determine trends, synthesize results, and deliver prioritized details through effective reporting
• Communication
  
  Skills:
  
  Strong communication and interpersonal skills for effective collaboration and education
• Project management (planning, status tracking, risk mitigation) for acquisitions and onboarding

Abilities:

• Attention to Detail:
  Precision is essential when reporting critical analysis to inform decision-making and operational change
• Ability to lead, motivate, and manage a diverse team effectively
• Time Management:
  Prioritize effectively, manage time, and meet deadlines in a challenging environment
• Interpret payer compliance rules and regulations; ensure audit readiness

Work Environment: This position may involve working in a variety of clinical and administrative settings, requiring adaptability and a proactive approach to problem-solving

Physical Demands: Frequent reaching, sitting, walking, and standing may be required. No special coordination beyond that used for normal mobility and handling of everyday objects and materials is needed to…