Provider Enrollment Manager

IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care.

Applicants must reside in a state IES operates in (AZ, CO, OK, TX, IN, AL, SC, FL)

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following.  Others may be assigned.

• Provide leadership and supervision to the Provider Enrollment team, including coaching, development, workload allocation, and performance management.
• Own the full lifecycle of provider and group enrollment with commercial and government payors; ensure accurate and timely submission of applications.
• Serve as the primary escalation point for enrollment-related issues, rejections, or payer delays.  Serve as the subject matter expert for group provider enrollment related matters.  Oversee new group set-ups and ensure required documentation is submitted to the billing company.
• Monitor and report on enrollment-related SLAs, KPIs, and A/R held due to enrollment issues; collaborate with the Billing team to mitigate risk.
• Ensure compliance with enrollment regulations and internal policies, including CAQH re-attestations, state-specific rules, and payer documentation standards.
• Lead efforts to resolve complex enrollment issues and support the team with payer or client-facing escalations.
• Maintain strong payer relationships and serve as a liaison to escalate unresolved enrollment bottlenecks.
• Partner with other departments including, but not limited to, Credentialing, Recruiting, Revenue Cycle, Finance, and Clinical Operations to ensure a seamless experience.
• Lead enrollment-related project initiatives, working closely with cross-functional partners and creating detailed plans and timelines to track progress.
• Support and refine reporting, dashboards, and analytics to track enrollment timelines and team productivity.
• Drive continuous improvement of workflows and procedures; collaborate with internal stakeholders to identify opportunities for automation or optimization.
• Maintain and enhance standard operating procedures (SOPs) and documentation for internal and external audits.
• Maintain up-to-date knowledge of payer and regulatory requirements and industry best practices; share guidance and lead changes accordingly.
• Foster a culture of accountability, operational excellence, and continuous improvement.
• Ensure that clinicians and clients receive top-tier services throughout the enrollment cycle.  Develop performance measurements to effectively maintain service level agreements and key performance indicators while adhering to budget. Create and maintain dashboards for the business and/or clinical or management company leadership.
• Maintain current subject matter knowledge and expertise regarding regulatory changes, trends, best practices, and technologies.  Use knowledge to provide advice and guidance surrounding solutions for enrollment.
• Manage to extremely high degree of accuracy with enrollment compliance to avoid timely filing or held A/R issues. Work closely with management, leadership and finance to analyze and resolve held A/R issues.  Facilitate meetings with billing company regarding enrollment status and current projects.
• Handle sensitive information in accordance with company protocols and ensure data security

QUALIFICATIONS

Knowledge, Skills, Abilities:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Strong working knowledge of provider enrollment processes and payer regulations (Medicare, Medicaid, commercial payors).
• Experience leading teams with multiple layers.
• Excellent interpersonal and communication skills, including the ability to interface with senior leadership and external partners.
• Strong analytical and problem-solving skills; ability to interpret data and implement performance improvements.
• Proficiency with Microsoft Office Suite (especially Excel), and experience with enrollment systems and tools.
• High attention to detail with the ability to manage competing priorities effectively.
• Knowledge of revenue cycle impact from enrollment delays or rejections.
• Strong customer service orientation and project management capabilities.
• Ability to use discretion appropriately and maintain confidentiality
• Ability to read, write and speak English proficiently

Education / Experience:  Include minimum education, technical training, and/or experience preferred to perform the job.

Required:

• High school diploma or GED
• Minimum 4 years provider enrollment experience
• Minimum 2 years prior leadership experience
• Experience working with multi-state or multi-payer environments

Preferred:

• Bachelor's degree
• Previous experience working with CAQH and payer portals 
• Familiarity with billing workflows and A/R management

PHYSICAL DEMANDS:  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
• While performing the duties of this job, the employee is regularly required to talk and hear
• Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms
• Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to:  remaining seated for periods of time to perform computer based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.)
• Occasionally lift and/or move up to 20-25 pounds 
• Fine hand manipulation (keyboarding)

WORK ENVIRONMENT:  The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office environment
• May visit hospital locations and vendors 
• The noise level in the work environment is usually low
• Although work may be performed remotely applicants must reside in a state IES operates in (AZ, CO, OK, TX, IN, AL, SC, FL)

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

The company is committed to creating a diverse, inclusive, and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds, experiences, and abilities and believe that the unique experiences of our team drive our success.