Director, Provider Enrollment

Description

JOB SUMMARY

The Director of Enrollment is responsible for the strategic oversight and daily management of all provider enrollment activities, ensuring timely and accurate enrollment with Medicaid, Medicare, and commercial payers across all applicable locations. This role is critical to securing uninterrupted reimbursement and supporting the organization’s ability to deliver care without administrative barriers.

The Director leads the development and implementation of efficient enrollment workflows, monitors compliance with payer-specific requirements, and ensures data integrity across all enrollment systems and processes. While this role works closely with credentialing teams, it does not include credentialing and privileging responsibilities.

A key function of this position is to maintain strong, collaborative communication across departments involved in the provider onboarding lifecycle—including Billing, Human Resources, Clinical Leadership, and Credentialing—to ensure providers are fully enrolled and operational as quickly and efficiently as possible. The Director also oversees the tracking and timely execution of revalidations and renewals to prevent lapses in participation status.

In addition, the Director of Enrollment ensures compliance with HRSA enrollment-related requirements and supports reporting obligations for the Uniform Data System (UDS). This leadership role requires strong project management skills, an in-depth understanding of payer enrollment practices, and the ability to navigate & anticipate delays in the enrollment process to optimize organizational readiness and provider access to care.

Work is performed in an office environment however, this position may offer a hybrid work option with departmental approval on a temporary or ongoing basis, allowing for remote work. Onsite presence is required for projects or team meetings as needed and on-site training is required. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job.

REPORTING RELATIONSHIPS
The position reports to the Vice President, Revenue Cycle Controller. This position oversees a team of enrollment specialists. 

ESSENTIAL JOB DUTIES

• Manage and lead the provider enrollment team in the execution of initial enrollments, timely revalidations, and updates in all locations applicable.
• Design and execute efficient, timely enrollment workflows while collaborating with cross-functional departments to optimize and streamline the overall enrollment process.
• Oversee the team regarding EDI/EFT/ERA enrollment efforts with payors and Clearinghouse to be sure all billing/collections can be submitted timely to the payors. 
• Oversee the end-to-end enrollment process including provider and facility locations.
• Collaborate with various business areas including Credentialing, Billing, Human Resources, Clinical Leadership and providers to ensure enrollment and reimbursement across all applicable locations. Provide weekly status updates to keep stakeholders informed and aligned.
• Ensure adherence to HRSA, Medicaid, Medicare, NCQA standards, and payer-specific enrollment requirements to maintain regulatory compliance.
• Establish, maintain and enforce internal policies and document standard operating procedures (SOP) to ensure timely enrollments and revalidations.
• Develop quality control processes, including regular internal audits, to mitigate risks and ensure the highest standards of provider enrollment.
• Serve as the main liaison for Managed Care Organizations (MCOs) on all matters related to provider enrollment.
• Track enrollment status and maintain accurate rosters in enrollment system(s), ensure the team is maintaining timely updates to payor portals and internal systems (e.g. CAQH, PECOS, Availity) .
• Maintain comprehensive physician database of applications, recertifications and internal communication sharing access with applicable departments. 
• Monitor the impact of enrollment delays on revenue and develop corrective action plans.
• Prepare for audits related to enrollment.
• Educate internal stakeholders on enrollment timelines, requirements, and compliance.
• Direct and mentor a team of provider enrollment specialists, establishing performance metrics, conducting performance evaluations, and fostering a culture of accountability, continuous improvement, and operational excellence.
• Research and resolve provider related enrollment issues and coordinate with members of various departments when applicable. 
• Perform additional duties as assigned by management.

Requirements

REQUIRED QUALIFICATIONS

• Bachelor’s degree in Business, Healthcare Administration or equivalent
• 3-5 years of experience in a healthcare setting with experience in leading provider enrollment
• Demonstrate ability to establish work priorities, delegate assignments as appropriate and follow through to ensure completion of activities
• Strong computer aptitude and proficiency in the use of Microsoft Excel, Word, PowerPoint and Google software
• Excellent data management & analytical skills with passion for details and “digging in”
• Strong organizational skills and ability to balance multiple priorities with a superior attention to detail in a dynamic environment; ability to drive process improvements 
• Demonstrate strong work ethic and a commitment to meeting deadlines, including the flexibility to manage increased workload and departmental pressures during critical periods
• Strong communication skills and collaboration ability with providers, payers and cross functional business teams
• Highly motivated with a drive to succeed
• Previous experience leading and managing teams & / or projects is required