Manager, Provider Enrollment & Managed Care Ops. Financial Admin, Full Time, Day

About the role

The Manager, Provider Enrollment and Managed Care Operations is responsible for the operational management, oversight and performance of Valley Health System's payer relations, provider enrollment and delegated credentialing functions. The position translates the organization's managed care strategy and contractual requirements into operational processes, establishes performance standards and ensures that payer, provider enrollment and delegated credentialing activities are executed accurately, timely and in compliance with applicable payer and regulatory requirements. This position provides direct leadership and oversight to the provider enrollment team, ensuring timely and accurate enrollment of providers with payers, maintenance of enrollment records, and resolution of enrollment-related issues. Position serves as internal owner of delegated credentialing matters and ensures that Valley remains compliant with all delegated credentialing requirements. This position also serves as a key subject matter expert for the system for any education related to insurance industry changes, managed care regulation, and impactful payer policies/protocol changes. The position serves as an internal resource and external liaison for managed care matters, coordinating input from Revenue Cycle, Payer Analytics, Legal, Finance, and clinical leadership to implement and operationalize payer strategies, policies or protocols and escalate health system payer issues. Job Location: Kraft Center.

Requirements

• Bachelor's Degree required.
• Minimum of five years' experience in managed care in a health care setting (medical office/hospital/insurance).
• Knowledge of the healthcare industry and payor reimbursement methodologies.
• Minimum of three years’ experience in payer enrollment; experience with delegated credentialing strongly preferred.

Skills

• Leadership and team management
• Managed care and payer operations expertise
• Provider enrollment and delegated credentialing knowledge
• Healthcare reimbursement and payer relations experience
• Strategic planning and operational oversight
• Process improvement and workflow optimization
• Analytical and problem-solving skills
• Contract interpretation and regulatory compliance
• Cross-functional collaboration and stakeholder management
• Strong written, verbal, and presentation skills
• Performance measurement and data analysis
• Change management and organizational influence
• Relationship management and customer service excellence

Benefits

• Medical/Prescription, Dental & Vision Discount Program (Full Time/Part Time Employees)
• Group Term Life Insurance and AD&D (Full Time Employees)
• Flexible Spending Accounts and Commuter Benefit Plans
• Supplemental Voluntary Benefits (e.g., Short-term and Long-term Disability, Whole Life Insurance, Legal Support, etc.)
• 6 Paid Holidays, Paid Time Off (varies), Wellness Time Off, Extended Illness
• Retirement Plan
• Tuition Assistance
• Employee Assistance Program (EAP)
• Valley Health LifeStyles Fitness Center Membership Discount
• Day Care Discounts for Various Daycare Facilities

Pay

Pay Range: $101,212.80 - $126,505.60 (full-time equivalent 1.0 FTE). Actual individual salaries vary depending on role, experience, education, and licensure; the listed salary does not include other forms of compensation or benefits.

Schedule

Shift: Day (United States of America)