Director of Provider Enrollment

Purpose

The Director, Provider Enrollment is responsible for overseeing the day-to-day operations of the Provider Enrollment department. This role requires strong leadership, a deep understanding of provider enrollment, healthcare operations, change management, and the ability to implement processes. The Director will focus on optimizing revenue, reducing denials and cycle time, standardizing processes, building and maintaining strong payer relationships, and ensuring positive client experiences.

Duties And Responsibilities

• Lead, mentor, develop a high performing provider enrollment team, fostering a culture of accountability, collaboration and continuous improvement
• Ensure operational processes are efficient and scalable
• Evaluate and improve existing provider enrollment processes and systems, leveraging technology, vendors, and best practices to enhance quality and productivity
• Monitor industry trends and regulatory changes to proactively adjust processes and ensure continued compliance
• Identify potential areas of risk and implement remediation strategies
• Comply with all State and Federal Laws regarding an effective Compliance Program inclusive of HIPAA Privacy and Security
• Adhere to the Code of Conduct and be familiar with all compliance policies and procedures stored in LogixGarden relevant to this position
• Ensure departmental managers and employees follow the Code of Conduct, compliance policies and procedures
• Administer the appropriate sanction when an employee violates a compliance policy or procedure

Qualifications

To perform this job successfully, an individual must be able to perform each duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities perform the duties.

Education (Degrees, Certificates, Licenses, Etc.)

• Bachelor’s degree in healthcare administration, business, or related field (Master’s degree preferred)
• Provider Enrollment Specialist Certificate (PESC) preferred
  
  

Computer Skills

Microsoft 365 intermediate to advanced proficiency.

Experience

Minimum of 10 years of operational leadership experience in healthcare provider enrollment or related area(s).

Specific Job Knowledge, Skill and Ability

• Demonstrated success in leading diverse teams
• Exceptional problem-solving skills and the ability to think strategically and execute operational initiatives
• Strong communication, interpersonal and leadership skills, with the ability to effectively manage cross[1]functional relationships
• Proven track record in managing provider data management systems, client and payer relationships
• Ability to apply common sense understanding to carry out instructions
• Specific vision abilities required by this job include close vision
• Ability to sit for prolonged periods of time, use hands, talk, hear and occasionally walk and reach with hands or arms
  
  

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