Director, Provider Enrollment

🕒 vor 1 Monat

🇺🇸 Vereinigte Staaten – Remote

💵 $126.422 - $189.634 / Jahr

⏰ Vollzeit

🔴 Experte

👔 Direktor

👻 Geisterscore 11%

Was es bedeutet: die Wahrscheinlichkeit, dass für diese Stelle niemand wirklich einstellt.So liest du es: 60 % oder höher heißt, wir halten das für einen Geisterjob. Niedrigere Werte sind weniger bedenklich.Warum dieser Wert:

• Seit 42 Tagen offen.
• Stellen bei diesem Unternehmen werden meist in 22 Tagen besetzt.

Jetzt Bewerben

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Alignment Health

WebsiteLinkedInAlle Stellen

501 - 1000 Mitarbeiter

Gegründet 2013

⚕️ Krankenversicherung

🛡️ Versicherung

🏥 Gesundheitswesen

💰 €135.000.000 Series C im 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health engagiert sich für die Bereitstellung umfassender Pflege für Medicare-Mitglieder, wobei der Fokus auf den Bedürfnissen von Senioren, chronisch Kranken und gebrechlichen Personen liegt. Mit der Mission, das Gesundheitswesen für Senioren zu transformieren, nutzt Alignment Health ein maßgeschneidertes Pflegemodell und fortschrittliche Technologie, um qualitativ hochwertige, kostengünstige Gesundheitsdienstleistungen anzubieten. Ihr 24/7-Konzierge-Pflegeteam arbeitet mit vertrauenswürdigen lokalen Anbietern zusammen, um sicherzustellen, dass jedes Mitglied eine individuelle Betreuung erhält, was das Engagement des Unternehmens widerspiegelt, alle Mitglieder als geschätzte Familienmitglieder zu behandeln.

Beschreibung

• 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

🎯 Anforderungen

• 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

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