(USA) Senior Manager, Enrollment Services - Health & Wellness

Position Summary

Our Health & Wellness Enrollment Services team is dedicated to ensuring Individual and Facility Providers are accurately and efficiently enrolled with multiple payers for pharmacy and optical claims reimbursement. We work cross-functionally to support access to care, strengthen provider experience, and advance the company’s mission of helping people save money and live better.

What you'll do

• Lead payer provider enrollment operations across Health & Wellness business.
• Lead and oversee facility and individual provider enrollment across Medicaid, MCO, Medicare, and commercial payers ensuring timely enrollment, compliance and alignment with state, federal, and internal requirements.
• Maintain a regional portfolio of states by ensuring timely, accurate enrollment submissions, monitoring due dates, portal issues, policy changes, and maintaining current SOPs.
• Lead appeals with Payers to reinstate and/or backdate enrollment when needed to prevent gaps in coverages, partnering across the team to resolve barriers while retaining accountability for final review and approval.
• Participate in Payer contracts and Provider Manual reviews with internal stakeholders.
• Develop and implement innovative strategies to streamline workflows, reduce processing times, and enhance overall provider experience, including the use of technology solutions to improve efficiency.
• Analyze key performance indicators (KPIs) and enrollment data to identify trends, areas for improvement, and opportunities for process optimization.
• Collaborate effectively with cross-functional teams (IT, legal, compliance, operations, contracting) to improve systems, procedures, and communication related to provider enrollment.
• Mentor and develop a high-performing team of enrollment coordinators, fostering a culture of continuous improvement and excellence.

What you'll bring

• Commitment to maintaining the highest ethical standards and fostering a strong organizational structure that prioritizes efficiency, accuracy, and compliance.
• Exceptional organizational skills and attention to detail, ensuring efficient and accurate enrollment processes.
• A deep understanding of regulatory requirements and industry standards related to provider enrollment, including familiarity with various payer types (governmental and commercial).
• Strong analytical skills and the ability to translate data insights into actionable strategies for process improvement.
• Prior work experience in revenue cycle management, billing, payer enrollment, or related area.
• Proven leadership and team management skills, with a demonstrated ability to build and motivate high-performing teams.
• Ability to travel domestically up to once per month.

Additional Compensation

• The annual salary range for this position is $90,000.00 - $180,000.00
• Additional compensation includes annual or quarterly performance bonuses.
• Additional compensation for certain positions may also include : Stock

Minimum Qualifications

• Option 1: Bachelor’s degree in healthcare administration, business, accounting, economics, or related area and 3 years’ experience in revenue cycle management, billing, payer enrollment, or related area.
• Option 2: 5 years’ experience in revenue cycle management, billing, payer enrollment, or related area. Prior work experience in eligibility and insurance verification processes, provider enrollment, and EDI practices. Prior work experience with enrolling providers and facilities in commercial and government plans across all 50 states. Prior work experience in NCQA, Joint Commission, URAC, CMS, and state laws and regulations involving provider credentials. Prior work experience in CAQH and credentialing processes.

Preferred Qualifications

• Master's degree in Healthcare Administration, Business, Accounting, Economics, or related area.
• NAMSS Credentialing/Enrollment Certification (CPCS, CPMSM).