Manager, Provider Enrollment - North American Partners in Anesthesia : Job Details

Melville,NY - USA

Position Requirements

PRIMARY RESPONSIBILITIES

• Provider Enrollment Management: Oversee all aspects of provider enrollment and credentialing, including initial applications, revalidations, and re-credentialing processes for government and commercial payers.

• Compliance and Regulatory Adherence: Maintain compliance with payer-specific requirements, federal/state regulations, and internal standards. Ensure all credentialing activities align with CMS, CAQH, PECOS, NPPES, and other relevant regulatory bodies.

• Team Leadership and Development: Supervise, mentor, and support the enrollment team. Conduct performance reviews, manage workloads, and provide ongoing training to ensure operational efficiency and staff development.

• Process Improvement: Evaluate and enhance enrollment workflows and tools to increase efficiency, accuracy, and accountability.

• Data Management: Ensure accuracy and completeness of provider data in credentialing systems and enrollment platforms (e.g., CAQH, QGenda, AthenaIDX). Maintain up-to-date provider files and documentation.

• Stakeholder Communication: Act as the primary contact for internal and external stakeholders regarding provider enrollment and credentialing issues. Manage relationships with internal operations teams, insurance companies, government agencies, and other entities.

• Reporting and Analytics: Track and report key performance metrics (e.g., days to enroll, rejections, pending applications). Analyze trends to identify bottlenecks to improve turnaround times and provide insights and recommendations based on trends and performance metrics.

• Problem Resolution: Address and resolve issues related to provider enrollment, including denied or rejected applications, discrepancies, and other challenges.

• Collaboration with Internal Teams: Coordinate closely with Revenue Cycle, Managed Care, Client Services, and Compliance teams to ensure seamless payer onboarding and revenue impact minimization.

• Support New Business Onboarding: Facilitate the enrollment of new providers and groups during practice acquisitions, site launches, and provider onboarding, ensuring timely participation with all necessary payers.

REQUIRED QUALIFICATIONS

• Minimum of 5 years of experience in provider enrollment and credentialing in a healthcare setting.
• At least 2 years of supervisory or management experience in a healthcare setting.
• Demonstrates knowledge of professional billing processes and reimbursement, and insurance protocols
• Strong working knowledge of provider data management systems, CAQH, PECOS, NPPES, and payer portals.
• Proficiency in Microsoft Office Suite, especially Excel (VLOOKUPs, pivot tables), Word, PowerPoint and Outlook
• Thorough understanding of CMS regulations, payer credentialing standards, and industry best practices
• Knowledge of revenue cycle functions and the impact of enrollment on billing and collections
• Excellent verbal and written communication skills, including presentation and facilitation in both one-on-one and group settings.
• Strong organizational and time management skills
• Ability to communicate with clarity, transparency, and professionalism across all levels of the organization.
• Ability to take initiative by identifying problems, conceptualizing resolutions, and implementing change
• Ability to make sound decisions with limited supervision
• Demonstrated ability to effectively motivate and inspire staff to achieve peak performance and professional growth.
• Ability to travel up to 10 to 15% as needed

PREFERRED QUALIFICATIONS

• Minimum 5 years of supervisory or management experience in a healthcare setting
• Associate or bachelor's Degree · Familiarity with EHR or practice management systems (e.g., AthenaIDX, Epic, etc.) preferred.
• Proven ability to lead process improvement initiatives or enrollment system implementations
• Experience developing and analyzing key performance indicators (KPIs) for provider enrollment workflows
• Expertise in payor enrollment and claims processing related to Government and Commercial payers

TOTAL REWARDS

• Salary: $82,376.62 -$113,267.86
• Generous benefits package, including:
  • Paid Time Off
  • Health, life, vision, dental, disability, and AD&D insurance
  • Flexible Spending Accounts/Health Savings Accounts
  • 401(k)
  • Leadership and professional development opportunities

The Provider Enrollment Manager is responsible for managing all provider enrollments, credentialing, and re-credentialing functions to ensure timely and accurate participation with government and commercial payers. This role ensures that all healthcare providers are properly credentialed and enrolled in accordance with payer and regulatory requirements. The Manager leads a team responsible for maintaining accurate provider data, submitting initial and re-enrollment applications, and ensuring compliance with all applicable standards. In addition, this role oversees the timely resolution of claim edits, rejections, and enrollment-related holds assigned to the Provider Enrollment team within Athena/IDX. The ideal candidate will have a strong understanding of payer enrollment processes, excellent organizational and communication skills, and demonstrated leadership experience in a healthcare or revenue cycle setting.

EEO Statement

North American Partners in Anesthesia is an equal opportunity employer.

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