Manager, Provider Enrollment & Managed Care Ops. Financial Admin, Full Time, Day

Valley Health System; Paramus (NJ); On-site; USD 101,000 - 127,000; Full time

Benefits offered by this job

Medical, Dental & Vision

Group Life Insurance

Flexible Spending Accounts and Commutr

Disability & Legal Support

Paid Holidays & PTO

Retirement Plan

Tuition Assistance

Employee Assistance Program

Fitness Center Membership Discount

Day Care Discounts

Job summary

Valley Health System is seeking a Manager, Provider Enrollment and Managed Care Operations to lead payer relations, provider enrollment and delegated credentialing, translating strategy into compliant operational processes and ensuring timely, accurate execution.

You will oversee enrollment records, resolve enrollment issues, and serve as a key internal/external resource on insurance industry changes, coordinating with Revenue Cycle, Payer Analytics, Legal, Finance and clinical leadership to

Qualifications

• Bachelor's degree required.
• Minimum five years in managed care in a health care setting.
• Minimum three years in payer enrollment with delegated credentialing.

Responsibilities

• Oversee provider enrollment and delegated credentialing operations.
• Lead payer relations and payer strategy implementation.
• Ensure regulatory compliance and accurate enrollment records.
• Collaborate with Revenue Cycle, Legal, Finance and clinical leadership to implement payer strategies.

Skills

Leadership and team management

Managed care operations

Provider enrollment

Healthcare reimbursement

Strategic planning

Process improvement

Analytics

Regulatory compliance

Cross-functional collaboration

Communication skills

Education

Bachelor's degree

Job description

Position Summary

The Manager, Provider Enrollment and Managed Care Operations is responsible for the operational management, oversight and performance of Valley Health System's payer relations, provider enrollment and delegated credentialing functions. The position translates the organization's managed care strategy and contractual requirements into operational processes, establishes performance standards and ensures that payer, provider enrollment and delegated credentialing activities are executed accurately, timely and in compliance with applicable payer and regulatory requirements. This position provides direct leadership and oversight to the provider enrollment team, ensuring timely and accurate enrollment of providers with payers, maintenance of enrollment records, and resolution of enrollment-related issues. Position serves as internal owner of delegated credentialing matters and ensures that Valley remains compliant with all delegated credentialing requirements. This position also serves as a one of the key subject matter experts for the system for any education related to insurance industry changes, managed care regulation, and impactful payer policies/protocol changes. The position serves as an internal resource and external liaison for managed care matters, coordinating input from Revenue Cycle, Payer Analytics, Legal, Finance, and clinical leadership to implement and operationalize payer strategies, policies or protocols and elevate health system payer issues.

Position Summary

The Manager, Provider Enrollment and Managed Care Operations is responsible for the operational management, oversight and performance of Valley Health System's payer relations, provider enrollment and delegated credentialing functions. The position translates the organization's managed care strategy and contractual requirements into operational processes, establishes performance standards and ensures that payer, provider enrollment and delegated credentialing activities are executed accurately, timely and in compliance with applicable payer and regulatory requirements. This position provides direct leadership and oversight to the provider enrollment team, ensuring timely and accurate enrollment of providers with payers, maintenance of enrollment records, and resolution of enrollment-related issues. Position serves as internal owner of delegated credentialing matters and ensures that Valley remains compliant with all delegated credentialing requirements. This position also serves as a one of the key subject matter experts for the system for any education related to insurance industry changes, managed care regulation, and impactful payer policies/protocol changes. The position serves as an internal resource and external liaison for managed care matters, coordinating input from Revenue Cycle, Payer Analytics, Legal, Finance, and clinical leadership to implement and operationalize payer strategies, policies or protocols and elevate health system payer issues.

Education

Bachelor's Degree required.

Experience

• A minimum of five years' experience in managed care in a health care setting (medical office/hospital/insurance) required.


• knowledge of the healthcare industry and payor reimbursement methodologies.


• A minimum of three years’ experience in payer enrollment with experience with delegated credentialing strongly preferred.

Skills

• Leadership and team management


• Managed care and payer operations expertise


• Provider enrollment and delegated credentialing knowledge


• Healthcare reimbursement and payer relations experience


• Strategic planning and operational oversight


• Process improvement and workflow optimization


• Analytical and problem-solving skills


• Contract interpretation and regulatory compliance


• Cross-functional collaboration and stakeholder management


• Strong written, verbal, and presentation skills


• Performance measurement and data analysis


• Change management and organizational influence


• Relationship management and customer service excellence

Job Location

Kraft Center

Shift

Day (United States of America)

Benefits

• Medical/Prescription, Dental & Vision Discount Program (Full Time/Part Time Employees)


• Group Term Life Insurance and AD&D(Full Time Employees)


• Flexible Spending Accounts and Commuter Benefit Plans


• Supplemental Voluntary Benefits ( e.g. Short-term and Long-term Disability, Whole Life Insurance, Legal Support, etc.)


• 6 Paid Holidays, Paid Time Off (varies), Wellness Time Off, Extended Illness


• Retirement Plan


• Tuition Assistance


• Employee Assistance Program (EAP)


• Valley Health LifeStyles Fitness Center Membership Discount


• Day Care Discounts for Various Daycare Facilities

Salary

Joining Valley Health System means becoming part of a dedicated team that values the highest quality of care in a supportive environment. In our commitment to high performance and reliability, we encourage and recognize exceptional individual performance through our industry leading compensation practices including a starting salary and benefits in accordance with your role, experience, education, and licensure. Actual individual salaries vary depending on these factors. The salary listed does not include other forms of compensation or benefits.

Pay Range: $101,212.80 - $126,505.60

The posted pay range reflects the compensation for a full-time equivalent (1.0 FTE)

EEO Statement

Valley Health System does not discriminate on the basis of ancestry, age, atypical hereditary cellular or blood trait, civil union status, color, creed, disability, domestic partnership, gender, gender identity or expression, familial status, genetic information, liability for service in the Armed Forces of the United States, marital status, medical condition or illness, mental or physical handicap, national origin, nationality, perceived disability, pregnancy, race, refusal to submit to genetic testing or make available results of such tests, religion, sex, sexual orientation, veteran’s status or any other protected basis, in accordance with all applicable Federal, State and Local laws. This applies to all areas of employment, including recruitment, hiring, training and development, promotion, transfer, termination, layoff, compensation, benefits, social and recreational programs, and all other conditions and privileges of employment.