Director, Provider Enrollment

Alignment Healthcare USA, LLC; Orange (CA); On-site; USD 126,000 - 190,000; Full time

Job summary

Alignment Health is seeking a Director of Provider Enrollment to lead end-to-end provider onboarding, contract implementation, and delegated credentialing. You will collaborate with Network Management, Credentialing, Provider Data, and Claims teams to ensure timely activation and accurate provider records across core systems.

The role emphasizes regulatory compliance with CMS/NCQA, data governance, and driving operational excellence through automation and process improvements to support growth

Qualifications

• 10+ years of healthcare operations experience within a health plan, MCO, provider network, or healthcare administration environment.
• 5+ years of leadership experience managing provider enrollment, credentialing, provider data management, network operations, or related functions.
• 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.

Responsibilities

• Lead the end-to-end provider enrollment function from contract execution through provider activation.
• Oversee provider 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 systems.
• Maintain policies and controls to ensure regulatory compliance and audit readiness.

Skills

Provider enrollment

Leadership

Regulatory compliance

Data governance

Process improvement

Stakeholder management

Education

Bachelor's degree in healthcare administration

Master's degree preferred

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.The Director of Provider Enrollment is responsible for leading provider enrollment operations across the health plan, ensuring accurate and timely provider onboarding, contract implementation, delegated credentialing roster management, and non-participating provider administration. This role provides strategic and operational leadership for all provider enrollment activities, driving regulatory compliance, provider data accuracy, network readiness, and operational efficiency.The Director serves as the primary business owner for end-to-end provider enrollment processes, overseeing contract setup and activation, delegated credentialing file/load governance, non-par provider management, and implementation of initial provider set up across core systems. The role partners closely with Network Management, Credentialing, Provider Data Management, Claims, Compliance, Configuration, and Technology teams to ensure providers are accurately represented and operationally ready to support member access and claims adjudication.Provider Enrollment & Contract Implementation• Lead the end-to-end provider enrollment function from contract execution through provider activation.• Oversee provider and entity onboarding activities, ensuring timely setup of all contracted providers, facilities, ancillary providers, IPAs, and delegated entities.• Establish and maintain governance for contract implementation workflows, ensuring alignment between contracting, credentialing, enrollment, and provider data teams.• Ensure provider records are accurately configured across all downstream operational systems.• Develop standardized enrollment procedures, controls, and quality assurance processes.Delegated Credentialing Management• Own the end-to-end operational management of delegated credentialing roster submissions and provider loads.• Establish delegated provider onboarding standards, submission requirements, loading protocols, and validation controls.• Partner with Delegation Oversight teams to ensure provider roster submissions meet regulatory, contractual, and accreditation requirements.• Monitor delegated provider load accuracy, turnaround times, and compliance with service level agreements.• Lead remediation efforts for roster discrepancies and audit findings.Non-Par and Out-of-Network Provider Management• Provide strategic oversight of non-participating and non-contracted provider enrollment processes.• Develop policies and workflows for setup, maintenance, monitoring, and reporting of non-par providers.• Partner with Claims, Network Management, and Provider Data teams to support accurate claims of adjudication and provider identification.• Ensure consistent application of business rules governing non-participating provider records.• Monitor trends and operational risks related to out-of-network provider activity.Provider Data Governance• Establish provider enrollment data standards and quality controls.• Lead data validation, reconciliation, and audit activities across enrollment and credentialing processes.• Develop performance metrics and dashboards to monitor provider onboarding, delegate load performance, inventory aging, and enrollment cycle times.• Support initiatives to improve provider directory accuracy and provider data integrity in partnership with Provider Data Management and Data Quality Management Director.Regulatory Compliance & Audit Readiness• Ensure provider enrollment operations comply with CMS, NCQA, State, and accreditation requirements.• Collaborate with Compliance and Credentialing leadership to support audits, surveys, and delegated oversight reviews.• Develop and maintain policies, procedures, and documentation supporting regulatory compliance.• Implement controls to mitigate operational and compliance risks.Leadership & Operational Excellence• Lead, develop, and mentor provider enrollment managers and operational teams.• Establish productivity, quality, and service performance standards.• Drive process improvement initiatives that leverage automation, workflow optimization, and technology solutions.• Partner with executive leadership to support network growth, market expansion, and strategic provider initiatives.• Manage departmental budgets, vendor relationships, and operational performance.Job Requirements:EXPERIENCERequired:• 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.Preferred:• Experience leading large-scale operational transformation initiatives.EDUCATIONRequired:• Bachelor's degree in healthcare administration, Business Administration, Public Health, or related field.Preferred• Master's degree a plus.SPECIALIZED SKILLS• 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.Pay Range: $126,422.00 - $189,634.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [e-mail].