Director, Provider Enrollment

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $126.4k - $189.6k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 0%

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 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

🎯 Requirements

• 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