Provider Enrollment & Managed Care Operations Manager

Valley Health; United States; On-site; USD 101,000 - 127,000; Full time

Benefits offered by this job

Medical, dental & Vision discount

Life Insurance

Voluntary Benefits

Paid Holidays

Retirement Plan

Tuition Assistance

Employee Assistance Program

Fitness Center Discount

Day Care Discounts

Job summary

Valley Health invites a Manager, Provider Enrollment and Managed Care Operations to lead payer relations, provider enrollment, and delegated credentialing across our health system. You will translate the organization''s managed care strategy into efficient, compliant operational processes and oversee enrollment records and related issues.

The role provides subject-matter expertise on insurance industry changes, managed care regulations, and impactful payer policies, acting as a central internal

Qualifications

• Bachelor's Degree is required.
• 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.
• Minimum of three years' experience in payer enrollment with experience with delegated credentialing strongly preferred.

Responsibilities

• Oversee payer relations, provider enrollment and delegated credentialing functions.
• Serve as internal owner of delegated credentialing and ensure regulatory compliance.
• Coordinate input from Revenue Cycle, Payer Analytics, Legal, Finance, and clinical leadership to implement payer strategies and policies.

Skills

Leadership and team management

Managed care and payer operations

Provider enrollment and delegated 3rd

Healthcare reimbursement

Contract interpretation and regulatory

Cross-functional collaboration

Data analysis

Change management

Communication

Performance measurement

Stakeholder management

Education

Bachelor's Degree

Job description

Valley Health invites a Manager, Provider Enrollment and Managed Care Operations to lead payer relations, provider enrollment, and delegated credentialing across our health system. You will translate the organization''s managed care strategy into efficient, compliant operational processes and oversee enrollment records and related issues.

The role provides subject-matter expertise on insurance industry changes, managed care regulations, and impactful payer policies, acting as a central internal