Manager, Provider Enrollment

Boston Children's Hospital; Boston (MA); On-site; USD 110,000 - 150,000; Full time

Benefits offered by this job

Flexible schedules

Health, vision and dental insurance

Child care subsidies

Student loan subsidies

Generous paid time off

Retirement plan (401(k)/403(b)

Tuition reimbursement

License and certification assistance

Cell phone plan discounts

Transit/ticket discounts

Job summary

Boston Children's Hospital seeks a Manager of Provider Enrollment to lead enrollment across BCH, the Physicians' Organization and Franciscan Children's Hospital. This role ensures timely, accurate enrollment with insurers, Medicaid programs, and licensing authorities while guiding the enrollment team and coordinating with clinical leaders for efficient operations.

The role requires strong regulatory knowledge, process improvement skills, and leadership to drive compliant enrollment and optimized

Qualifications

• Associate degree required; Bachelor's preferred.
• Minimum of 3 years of provider enrollment experience.
• Knowledge of applicable state and federal laws governing hospitals, providers, and billing practices.
• Familiarity with Massachusetts insurance market.
• Experience leading enrollment teams and managing priorities.

Responsibilities

• Oversee provider and facility enrollment across BCH and partners.
• Manage enrollment with contracted plans and Medicaid programs.
• Maintain relationships with plans and ensure NCQA and regulatory compliance.
• Collaborate with leaders to improve enrollment processes and outcomes.
• Lead the enrollment team: hiring, training, performance, and workforce planning.
• Monitor staffing levels and budget alignment with organizational standards.
• Develop educational materials on enrollment processes for enterprise use.

Skills

Team leadership

Regulatory knowledge

Process improvement

Project management

Communication

Analytical thinking

Attention to detail

Stakeholder management

Problem solving

Education

Associate degree

Bachelor's degree

Tools

Enrollment software

Microsoft Office

Job description

Position Summary

The Manager, Provider Enrollment oversees provider and facility enrollment activities across the Boston Children's Hospital enterprise, including the Physicians' Organization and Franciscan Children's Hospital. Reporting to the Director of Provider Enrollment, this role ensures timely, accurate, and compliant enrollment with contracted insurance plans, out-of-state Medicaid programs, and applicable state licensing authorities. The Manager leads the Provider Enrollment Team, manages delegated relationships with insurance plans, and collaborates with clinical and administrative leaders to support operational efficiency, regulatory compliance, and reimbursement objectives.

Key Responsibilities

• Manage provider and facility enrollment across Boston Children's Hospital, the Physicians' Organization and its related foundations, and Franciscan Children's Hospital, ensuring timely and accurate enrollment in accordance with contractual and regulatory requirements.
• Oversee enrollment with contracted insurance plans, out-of-state Medicaid programs, and out-of-state licensing authorities.
• Manage delegated relationships with insurance plans, including contract review and compliance with National Committee for Quality Assurance (NCQA) standards and applicable state and federal regulations.
• Collaborate with clinical and administrative leaders to identify opportunities for process improvement, strengthen enrollment operations, and support quality and performance initiatives.
• Lead the Provider Enrollment Team, including hiring, training, staff development, performance management, and workforce planning.
• Monitor staffing levels and recommend adjustments to maintain operational effectiveness and compliance with organizational standards.
• Develop and present educational materials and informational sessions on provider enrollment processes and requirements to support enterprise-wide reimbursement strategies.
• Manage the Provider Enrollment Team budget in collaboration with the Physicians' Organization and partner with the Director to identify operational and strategic priorities.

Qualifications Required

• Associate's degree required; Bachelor's degree preferred.
• Minimum of 3 years of related provider enrollment experience.
• Knowledge of applicable state and federal laws and regulations governing hospitals, providers, and billing practices.
• Familiarity with Massachusetts insurance market.
• Working knowledge of provider and facility enrollment requirements, hospital bylaws, insurance contracts, and applicable regulatory standards.
• Team management experience and the ability to lead, develop, and motivate staff while managing departmental priorities and performance.
• Strong attention to detail, ensuring accuracy, completeness, and compliance across complex enrollment processes.
• Analytical and problem-solving skills, with the ability to identify issues, evaluate options, and implement effective solutions.
• Strong written and verbal communication skills, with the ability to work effectively with diverse internal and external stakeholders.
• Ability to influence and negotiate with senior leaders and managers on matters affecting multiple departments.
• Strong project management, organizational, and time management skills, with the ability to manage competing priorities and deadlines.
• Advanced proficiency with computer systems and software used in provider and facility enrollment operations.

The posted pay range is Boston Children's reasonable and good-faith expectation for this pay at the time of posting.

Any base pay offer provided depends on skills, experience, education, certifications, and a variety of other job-related factors. Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.