Strategic Lead, Provider Enrollment & Payer Operations

RiseMe; Blacksburg (VA); On-site; USD 101,000 - 127,000; Full time

Benefits offered by this job

Medical benefits

Life Insurance

FSAs & Commuter benefits

Disability plans

Paid holidays & PTO

Retirement plan

Tuition assistance

EAP

Fitness center membership

Day care discounts

Job summary

Valley Health System is seeking a Manager, Provider Enrollment and Managed Care Operations to oversee payer relations, provider enrollment, and delegated credentialing. You will translate strategy into compliant operations, lead a enrollment team, and act as a SME for payer policy changes.

The role emphasizes education for staff on industry changes, coordination across Revenue Cycle, Legal, and Finance, and ensuring timely, accurate enrollment with payers.

Qualifications

• Bachelor's Degree required.
• 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.

Responsibilities

• Lead and oversee payer relations, provider enrollment and delegated credentialing programs.
• Translate managed care strategy into operational processes with compliance across payers and regulators.
• Provide education and expertise on insurance industry changes and payer policy updates to system leadership.

Skills

Leadership

Managed care

Provider enrollment

Healthcare reimbursement

Strategic planning

Process improvement

Analytical skills

Regulatory compliance

Stakeholder management

Communication skills

Data analysis

Change management

Relationship management

Education

Bachelor's Degree

Job description

Valley Health System is seeking a Manager, Provider Enrollment and Managed Care Operations to oversee payer relations, provider enrollment, and delegated credentialing. You will translate strategy into compliant operations, lead a enrollment team, and act as a SME for payer policy changes.

The role emphasizes education for staff on industry changes, coordination across Revenue Cycle, Legal, and Finance, and ensuring timely, accurate enrollment with payers.