Provider Enrollment, Manager

Acentra; Northern (KY); Hybrid; USD 76,000 - 95,000; Full time

Job summary

Acentra Health is seeking a Provider Enrollment Manager to lead daily provider network operations and enrollment activities, ensuring accurate data across internal systems and close collaboration with clients to meet contract requirements.

You will manage a team of coordinators and specialists, oversee HIPAA-compliant processes, maintain communications with payers, and drive timely enrollment while upholding quality and compliance standards.

Qualifications

• High School diploma or GED required; Bachelor's degree preferred.
• Leadership experience in a healthcare payer environment is required.
• Experience with provider enrollment processes and government payer requirements is preferred.
• Strong communication and organization skills.

Responsibilities

• Oversee daily provider network and recruitment operations and keep databases updated.
• Maintain communication with payer representatives to ensure correct provider enrollment.
• Respond to provider inquiries and clarify requirements.
• Maintain internal/external databases with enrollment data.
• Manage confidential information with discretion.
• Establish enrollment protocols and minimize revenue delays or losses.
• Ensure provider information is up to date in the system.
• Manage provider newsletters, materials, and meetings or trainings.
• Adhere to HIPAA, privacy, and security policies.

Skills

Leadership experience in a healthcare

Education

High School diploma or GED

Bachelor's degree preferred

Bachelor’s degree in Healthcare Administration, Healthcare Management, or related field (preferred)

Tools

Microsoft Excel

Microsoft Office applications

Job description

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary and Responsibilities

Acentra Health is looking for a Provider Enrollment Manager to join our growing team.

Job Summary:

The Provider Enrollment Manager, your role involves overseeing daily provider network and recruitment operations keeping internal databases updated, interfacing with our client and understand the requirements and responsibilities, and general program management.

Responsibilities:

• Oversee provider recruitment, enrollment, maintenance program for OHA Open card FFS program
• Maintain constant and open communication with payer representatives to ensure that providers enroll correctly.
• Respond to provider requests, issues, inquiries and clarify requirements.
• Maintain multiple internal and external databases to keep track of provider and payer enrollment data.
• Manage confidential information with discretion.
• Establish protocols and minimize potential revenue delays or losses as the main point of contact for providers going through the provider enrollment process.
• Keep application information up to date in the organization's system.
• Manage information and documentation, including provider newsletters, provider materials, and onsite provider meetings or trainings.
• Maintain confidentiality.
• Ensure that the program's services meet or exceed contract deliverables.
• Meet mandatory deadlines and project standards.
• Manage a team of up to 15, multi-disciplinary coordinators, Provider Education Specialist, Provider Enrollment, and Provider Relations Specialists
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Qualifications

Required Qualifications

• High School diploma or GED (Bachelor's degree is preferred)
• Leadership experience in a healthcare organization (Payer)
• 2+ years' experience with healthcare system design, development and implementation (DDI)
• 3+ years leading provider enrollment operations, service delivery
• Knowledge of provider enrollment requirements for government agencies (CMS), payor organizations, and insurance regulations.
• Proficient in Microsoft Excel, and other Microsoft Office applications.
• Strong customer service skills.

Preferred Qualifications

• PMP is preferred
• Resident of State of Georgia
• Bachelor’s degree in Healthcare Administration, Healthcare Management, or general Business Administration or related field of study (preferred)

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is listed below.

“Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”

Pay Range

USD $76,200.00 - USD $95,200.00 /Yr.

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.