Provider Enrollment Manager

Key Responsibilities

• Build an outstanding team culture through consistent engagement
• Foster professional development of all direct and indirect reports, especially the next generation of CHOP leaders
• Identify, deploy, and maintain best practices in revenue cycle operations
• Understand and monitor Key Performance Indicators (KPIs), and take quick and appropriate action to maintain the financial health of CHOPPA
• Oversee the day-to-day operations of provider enrollment activities, ensuring timely and accurate enrollment, revalidation, and maintenance of provider records across all payers
• Lead a team of enrollment professionals, drive operational efficiency, and support revenue cycle performance through effective enrollment processes
• Partner cross-functionally with internal stakeholders, including clinical and revenue cycle teams, and serve as a key escalation point for complex enrollment issues
• Support workflow optimization within Credentialing systems (e.g. CredentialStream) and leverage reporting insights to improve performance, while maintaining a strong focus on team leadership, process consistency, and service excellence

What You Will Do

• Team Leadership & Oversight
• Lead, coach, and develop a team of Provider Enrollment Coordinators and/or Specialists
• Recruit, train, mentor, and evaluate staff to ensure high performance and professional development
• Establish clear performance expectations, productivity standards, and accountability measures
• Conduct regular team meetings, one-on-ones, and performance evaluations
• Support onboarding and training of new team members
• Foster a culture of accuracy, urgency, collaboration, and continuous improvement
• Enrollment Operations & Workflow Management
• Oversee the full lifecycle of provider enrollment, including: initial enrollment, revalidation and recredentialing, updates, and terminations
• Ensure timely submission, tracking, and follow-up of all enrollment applications
• Monitor work queues and ensure appropriate prioritization of tasks
• Workflow Optimization & Process Improvement
• Identify inefficiencies in enrollment workflows and implement process improvements
• Standardize procedures to ensure consistency across the team
• Partner with leadership on larger process improvement initiatives
• Support system enhancements and workflow optimization efforts
• Regulatory Compliance & Data Integrity
• Ensure provider enrollment activities comply with all applicable federal, state, and payer-specific requirements
• Maintain current knowledge of payer enrollment rules, regulatory updates, and industry best practices
• Partner with Compliance and Credentialing teams to support audit readiness and regulatory inquiries
• Ensure accuracy and integrity of provider enrollment data across systems
• Monitor and address compliance-related risks within enrollment workflows
• Performance Monitoring & Reporting
• Track and monitor key performance indicators such as enrollment turnaround times and application aging
• Provide regular reporting and insights to leadership
• Identify trends and implement corrective actions to improve performance
• Issue Resolution & Escalation Management
• Serve as the primary escalation point for complex enrollment issues and payer-related challenges
• Partner with internal stakeholders to resolve delays, denials, and discrepancies
• Maintain strong relationships with payer representatives to facilitate issue resolution
• Cross-Functional Collaboration
• Collaborate with Credentialing, Medical Staff Services, Billing, and Operations teams
• Support provider onboarding and readiness for billing
• Participate in organizational initiatives related to enrollment and revenue cycle operations

Education Qualifications

• A High School Diploma / GED is required
• A Bachelor's Degree is preferred

Experience Qualifications

• At least five (5) years experience in provider enrollment and/or credentialing with large healthcare organizations, Medicare and Medicaid is required
• At least three (3) years leadership or supervisory or leadership role within a healthcare environment is required

Skills And Abilities

• Strong knowledge of: CMS (Medicare/Medicaid) enrollment processes; Commercial payer enrollment requirements; CAQH, PECOS, NPPES, and payer portals (e.g., Availity)
• Understanding of revenue cycle workflows and financial impact of enrollment delays
• Excellent leadership, coaching, and team development skills
• Strong analytical and problem-solving abilities
• Advanced organizational and time management skills
• High attention to detail and commitment to data accuracy
• Strong communication and interpersonal skills, with ability to work cross functionally
• Knowledge of HIPAA and data privacy requirements

Pay & Benefits

SALARY RANGE: $92,100.00 - $117,400.00 Annually

This job is eligible for an incentive program. At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting.