Director, Provider Enrollment

🕒 6 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $126.422 - $189.634 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

👻 Score fantasma 0%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

Alignment Health

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 2013

⚕️ Seguro de Saúde

🛡️ Seguros

🏥 Saúde

💰 $135.000.000 Series C em 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health está comprometida em fornecer cuidados abrangentes para membros do Medicare, enfatizando as necessidades dos idosos, dos cronicamente doentes e daqueles que são frágeis. Com a missão de transformar a saúde dos idosos, a Alignment Health utiliza um modelo de atenção personalizado e tecnologia avançada para oferecer serviços de saúde de alta qualidade e baixo custo. Sua equipe de atendimento de concierge 24 horas por dia, 7 dias por semana, colabora com provedores locais confiáveis para garantir que cada membro receba um atendimento personalizado, refletindo o compromisso da empresa em tratar todos os membros como membros valiosos da família.

Descrição

• Lead the end-to-end provider enrollment function from contract execution through provider activation • Oversee provider and entity onboarding activities for contracted providers, facilities, ancillary providers, IPAs, and delegated entities • Establish governance for contract implementation workflows across contracting, credentialing, enrollment, and provider data teams • Ensure provider records are accurately configured across downstream operational systems • Develop standardized enrollment procedures, controls, and quality assurance processes • Manage delegated credentialing roster submissions, provider loads, onboarding standards, loading protocols, and validation controls • Partner with Delegation Oversight teams to meet regulatory, contractual, and accreditation requirements • Monitor delegated provider load accuracy, turnaround times, and service-level agreement compliance • Lead remediation for roster discrepancies and audit findings • Oversee non-participating and non-contracted provider enrollment processes, policies, workflows, monitoring, and reporting • Partner with Claims, Network Management, and Provider Data teams to support accurate claims adjudication and provider identification • Establish provider enrollment data standards and quality controls • Lead data validation, reconciliation, and audit activities • Develop performance metrics and dashboards for provider onboarding, delegate load performance, inventory aging, and enrollment cycle times • Support provider directory accuracy and provider data integrity initiatives • Ensure compliance with CMS, NCQA, state, and accreditation requirements • Support audits, surveys, and delegated oversight reviews • Maintain compliance policies, procedures, and documentation • Implement controls to mitigate operational and compliance risks • Lead, develop, and mentor provider enrollment managers and operational teams • Establish productivity, quality, and service performance standards • Drive process improvement through automation, workflow optimization, and technology solutions • Partner with executive leadership on network growth, market expansion, and strategic provider initiatives • Manage departmental budgets, vendor relationships, and operational performance

🎯 Requisitos

• 10+ years of healthcare operations experience within a health plan, managed care organization, provider network, or healthcare administration environment • 5+ years of leadership experience managing provider enrollment, credentialing, provider data management, network operations, or related functions • Demonstrated experience managing delegated credentialing programs and provider roster governance • Experience overseeing provider contract implementation and onboarding operations • Strong knowledge of provider data, credentialing, enrollment, and network management processes • Bachelor's degree in healthcare administration, Business Administration, Public Health, or related field • Deep understanding of provider enrollment operations, delegated credentialing, delegation oversight, provider data management, network administration, non-par and out-of-network provider processing, CMS and NCQA requirements, provider directory accuracy standards, and claims and downstream operational impacts • Strong analytical and operational leadership skills • Excellent stakeholder management and executive communication capabilities