Payer Enrollment & Managed Care Ops Lead

Valley Medical Services Inc; Paramus, Northern (NJ, KY); Hybrid; USD 101,000 - 127,000; Full time

Benefits offered by this job

Medical/Prescription, Dental & Vision

Group Term Life Insurance & AD&D

Flexible Spending Accounts & Commuter

Educational/Tuition Assistance

Employee Assistance Program (EAP)

Retirement Plan

Wellness Center membership discount

Paid Holidays & PTO

Day care discounts

Job summary

Valley Health System is seeking a Manager of Provider Enrollment and Managed Care Operations to lead payer relations, enrollment and delegated credentialing. You will translate strategic goals into operational processes, establish performance standards, and ensure compliant, timely execution across teams.

The role oversees a provider enrollment team, maintains enrollment records, resolves enrollment issues, and serves as a subject matter expert on payer policy changes and regulatory updates

Qualifications

• Minimum five years' experience in managed care in a health care setting.
• Experience with payer enrollment and delegated credentialing is strongly preferred.
• Knowledge of healthcare payor reimbursement methodologies.

Responsibilities

• Oversee and manage payer relations, provider enrollment and delegated credentialing operations.
• Translate managed care strategy into operational processes and standards.
• Lead the provider enrollment team to ensure timely, accurate enrollment and issue resolution.
• Coordinate input from Revenue Cycle, Payer Analytics, Legal, Finance and clinical leadership to implement payer strategies.

Skills

Leadership

Team management

Managed care expertise

Payer relations

Enrollment & credentialing

Strategic planning

Operational oversight

Process improvement

Data analysis

Regulatory compliance

Cross-functional collaboration

Communication skills

Education

Bachelor's Degree

Job description

Valley Health System is seeking a Manager of Provider Enrollment and Managed Care Operations to lead payer relations, enrollment and delegated credentialing. You will translate strategic goals into operational processes, establish performance standards, and ensure compliant, timely execution across teams.

The role oversees a provider enrollment team, maintains enrollment records, resolves enrollment issues, and serves as a subject matter expert on payer policy changes and regulatory updates