Director, Provider Enrollment

🕒 il y a 1 mois

🇺🇸 États-Unis – Télétravail

💵 $126 422 - $189 634 / an

⏰ Temps Plein

🔴 Expert

👔 Directeur

👻 Score fantôme 9%

Ce que ça veut dire : la probabilité que personne ne recrute vraiment pour cette offre.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Alignment Health

Site WebLinkedInTous les Emplois

501 - 1000 employés

Fondée en 2013

⚕️ Assurance santé

🛡️ Assurance

🏥 Santé

💰 €135 000 000 Series C en 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health se consacre à fournir des soins complets pour les membres de Medicare, en mettant l'accent sur les besoins des personnes âgées, des personnes atteintes de maladies chroniques et des personnes fragiles. Avec pour mission de transformer les soins de santé pour les seniors, Alignment Health utilise un modèle de soins personnalisé et une technologie avancée pour offrir des services de santé de haute qualité à faible coût. Leur équipe de soins de conciergerie disponible 24h/24 et 7j/7 collabore avec des prestataires locaux de confiance pour s'assurer que chaque membre reçoit des soins personnalisés, reflétant l'engagement de l'entreprise à traiter tous les membres comme des membres de la famille précieux.

Description

• 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

🎯 Exigences

• 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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