Director, Provider Enrollment

Ventra Health, Inc.; Northern (KY); Hybrid; USD 110,000 - 150,000; Full time

Benefits offered by this job

Incentive plan

Referral bonus

Rewards program

Job summary

Ventra Health, a leading provider of revenue cycle management solutions for physician practices, seeks a Director of Provider Enrollment to lead the enrollment team and oversee day-to-day operations.

You will manage workflows, develop client relationships, and drive the enrollment lifecycle from onboarding to denials resolution, ensuring accuracy and timeliness.

Qualifications

• Bachelor’s degree in Healthcare Administration or equivalent preferred.
• At least five years in physician/hospital billing or provider enrollment.
• At least two years of supervisory/leadership experience.

Responsibilities

• Directs Provider Enrollment department day-to-day operations and staff.
• Builds relationships with enrollment teams and clients; reports status updates.
• Optimizes enrollment lifecycle including new, reenrollment, denials, and projects.
• Implements policies and procedures for consistent department-wide adoption.
• Leads regular management meetings to review claims, enrollment status, and inventory.
• Generates management reports to analyze trends and inform decisions.

Skills

Leadership

Team management

Communication

Project management

Data analysis

Credentialing knowledge

CAQH knowledge

EDI systems

Education

Bachelor’s in Healthcare Admin

Tools

CAQH

EDI systems

Job description

About Us

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

Come Join Our Team!

• As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards

Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus!

Job Summary

Under administrative direction, the Director of Provider Enrollment is responsible for the strategic leadership and operational oversight of the Provider Enrollment function, including team performance, day-to-day enrollment activities, and the effective delivery of provider enrollment services.

Essential Functions and Tasks

• Directs, leads, and manages the Provider Enrollment department’s day to day operations, recruits, selects, orients, trains, coaches, counsels, and disciplines staff
• Develops relationships with the Provider Enrollment teams and documents needs and organizational priorities
• Ensures success of the provider enrollment lifecycle by monitoring client level metrics as well as ensuring timeliness and accuracy of team’s enrollment activities related to new enrollment, reenrollment, enrollment denials and client level special projects
• Develops relationships with clients and provides regular status updates on credentialing related deliverables
• Makes recommendations on work-flow processes throughout the enrollment cycle to assist in achieving consistency and success
• Develops and makes recommendations on policies, guidelines, and implements procedures to ensure consistent department-wide implementation and adherence
• Holds monthly (or as warranted) meetings with all levels of management to review held claims, status of client provider enrollment, overall provider enrollment inventory, etc.
• Monitors timeliness and effectiveness of department activities, implements processes to identify gaps
• Compiles and prepares a variety of reports for management in order to analyze trends and make recommendations
• Performs special projects and other duties as assigned

Education and Experience Requirements

• High School diploma or equivalent
• Bachelor’s Degree in Healthcare Administration, Business Administration, Benefits, or equivalent training and/or experience preferred
• At least five (5) years of physician billing, hospital billing, or vendor management experience in provider enrollment functions
• At least two (2) years of supervisory/management/leadership experience preferred
• Experience with CAQH database, NPI website and maintaining EDI, EFT, and ERA processes preferred

Knowledge, Skills, and Abilities

• Knowledge of provider enrollment requirements for physician billing and multi-state experience preferred
• Knowledge of business and financial processes, procedures, and processes
• Knowledge of medical terminology and anatomy
• Knowledge of requirements of medical record documentation
• Strong supervisory/management skills
• Strong leadership development and team building skills
• Strong management level oral, written, and interpersonal communication skills
• Strong financial reporting skills
• Strong healthcare data analysis skills
• Strong presentation development and delivery skills
• Strong word processing, spreadsheet, database, and presentation software skills
• Strong decision-making skills
• Strong problem-solving skills
• Strong organizational skills
• Strong time management skills
• Strong mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages, areas, and volumes; and working with decimals
• Ability to effectively present information, including financial reporting and healthcare analytics, and respond to questions from groups of executives, managers, clients, and customers
• Ability to adapt communication style to suit different audiences
• Ability to communicate with business stakeholders and IT staff in a tactful, mature, and professional manner
• Ability to know how and when to involve key players and effectively use internal employer resources to provide the best solution
• Ability to initiate and maintain professional relationships.
• Ability to see reoccurring issues and fixing them or identify and solve front end issues Ability to communicate with diverse personalities in a tactful, mature, and professional manner

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.

• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Ventra Health

Equal Employment Opportunity (Applicable only in the US)Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.Recruitment AgenciesVentra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.Solicitation of PaymentVentra Health does not solicit payment from our applicants and candidates for consideration or placement.

Statement of AccessibilityVentra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.