Strategic Enrollment & Credentialing Lead

MDVIP LLC; Boca Raton (FL); On-site; USD 100,000 - 130,000; Full time

Benefits offered by this job

Competitive base salary

Health, dental, vision insurance

Retirement plans

Professional development

Job summary

MDVIP is a national leader in personalized healthcare, empowering over 425,000 members with a network of more than 1,400 concierge primary care physicians. We are seeking a strategic Provider Enrollment Manager to lead credentialing, contracting, and enrollment initiatives across the organization.

The role partners with Insurance Services to resolve complex issues, ensuring compliance, data integrity, and executive‑level reporting.

Qualifications

• Demonstrated leadership experience managing provider enrollment or credentialing functions in a complex, matrixed environment.
• Strong analytical and critical thinking skills, with the ability to interpret complex data and translate findings into business insights.
• Effective relationship builder with physicians, staff, payers, and cross‑functional stakeholders.
• Clear, professional communicator with the ability to influence across diverse audiences.
• Proactive, solutions‑oriented leader who drives accountability, continuous improvement, and operational excellence.
• Strong organizational and execution skills, with a consistent focus on deadlines, accuracy, and outcomes.
• Strategic thinker with the ability to assess risk, identify trends, and inform decision‑making at the leadership level.

Responsibilities

• Leads and provides direction, coaching, and performance management for the Provider Enrollment team, ensuring strong execution, skill development, and accountability.
• Oversees team workflows, prioritization, and productivity to ensure all enrollment, credentialing, and contracting requirements are met timely and accurately.
• Manages complex, non‑standard enrollment and contracting scenarios, guiding resolution of exceptions, escalations, and payer‑specific requirements.
• Accountable for end‑to‑end enrollment and provider enrollment operations, ensuring compliance, data accuracy, and high‑quality service delivery.
• Serves as primary subject matter expert and liaison, driving alignment across physicians, internal stakeholders, payers, and external partners.
• Leads governance of provider enrollment data, ensuring integrity, reconciliation, and identification of risks impacting revenue, access, and compliance.
• Monitors program performance through reporting and analytics, identifying trends and driving continuous improvement.
• Evaluates payer participation strategies and physician‑specific needs, providing guidance on best practices, payer mix, timelines, and revenue impact.
• Oversees escalated and high‑priority cases, ensuring resolution aligns with compliance and organizational standards.
• Partners with Leadership and Legal to identify and mitigate contractual risks or conflicts.
• Ensures adherence to credentialing and contracting timelines, renewals through proactive management.
• Develops and delivers training, onboarding, and ongoing skill development for team members and stakeholders.
• Conducts research and resolves complex enrollment and credentialing issues with federal and commercial payers.
• Maintains subject matter expertise through ongoing education and awareness of industry trends.
• Complete statewide credentialing applications to establish new groups and add providers to commercial payers and Medicare
• Conducts detailed analysis and reconciliation of provider enrollment information across multiple systems proactively identifying discrepancies, downstream risks, and potential red flags.
• Provide training and guidance to affiliates, physician staff or respective billing companies related to MDVIP, when requested, on preventive billing protocols and/or provider enrollment needs.
• Represent the Provider Enrollment team during virtual and onsite corporate visits, serving as the subject matter expert, including Enrollment workflows, historical and regional performance metrics, and practice specific considerations to support physician onboarding during corporate visits.
• Manage complex and escalated provider enrollment cases, including high‑priority physicians payer‑specific expectations requiring advanced expertise, out of network scenarios, best practices, and reimbursement implications, ensuring alignment with organizational policy and compliance standards.
• Deliver new hire training for Provider Enrollment staff, ensuring team members receive comprehensive instruction on systems, workflows, payer requirements, and internal policies.

Skills

Leadership

Analytical thinking

Communication

Relationship building

Problem solving

Organization

Strategic thinking

Education

Associate's degree

Two+ years related business experience

Tools

EMR systems

Credentialing software

Microsoft Office

CAQH

PECOS

NPPES

Salesforce

NetDocs

athena

Job description

MDVIP is a national leader in personalized healthcare, empowering over 425,000 members with a network of more than 1,400 concierge primary care physicians. We are seeking a strategic Provider Enrollment Manager to lead credentialing, contracting, and enrollment initiatives across the organization.

The role partners with Insurance Services to resolve complex issues, ensuring compliance, data integrity, and executive‑level reporting.